Shoulder Examination Flashcards
What is the order of the shoulder examination (12)
- Observation
- History
- Inspection of skin and bony landmarks
- UQS as needed (prn)
- AROM
- PROM
- Joint play/accessory motion
- Muscle performance
- Anthropometrics
- Special tests
- Functional testing
- Provocative palpation
What do you observe during the examination of the shoulder (6)
- Posture
- Protection of arm
- Head position/protection
- Affect/demeanor
- Limb position
- Movement patterns
What are 3 common limb positions with shoulder problems
- Adducted and IR
- Cradled/supported
- Hand on top of head
What is the hand on top of the head called
Bakody’s Sign
Is Bakody’s sign a shoulder problem
No
What type of problem is Bakody’s sign
Cervical pain C4-6 (median nerve)
What are 3 common movement patterns with shoulder problems
- Total neglect
- Elbow down movement only
- Substitution
What are some substitutions of the shoulder (3)
- Scapular
- Trunk
- Head
What should you ask about in the patient history interview (9)
- Age
- Occupation
- Develpomental hx
- Living environment
- Meds
- Other medical intervention
- Health status
- Behavioral health risks
- Functional status and activity level
What else should you ask about in the patient history (7)
- Area of complaints
- Duration since onset
- MOI
- Nature of complaint
- Behavior of complaint
- Review of systems
- Functional status
50% of the patients referred to PT have at least one of these comorbidities (12)
- Hypertension
- Depression
- Asthma
- Chemical dependency
- Anemia
- Thyroid problems
- Cancer
- Diabetes
- RA
- Kidney problems
- Hepatitis
- Heart attack
What are the warning signs that pathology may be visceral (8)
- Pain is constant
- Insidious onset
- Pain described as throbbing, pulsating, deep aching, knifelike or colicky
- Rest doesn’t relieve pain or symptoms
- Constitutional symptoms present
- Pain changes in relation to organ function
- Pain worse during sleeping
- Shoulder pain increases with exertion activity that does not stress the shoulder
What are the constitutional symptoms (8)
- Fever
- Night sweats
- Nausea
- Vomiting
- Pale skin
- Dizziness
- Fatigue/malaise
- Unexplained weight loss
What amount of unexplained weight loss do you look for
Greater than 5% body weight
What oragns cause mid scapular pain (3)
- Liver
- Pancreas
- Gallbladder
What is being older the 50 a red flag for
Risk of RC tear or other serious pathology
What is night pain a red flag for
Risk of serious pathology
What is weight loss a red flag for
Risk of cancer or autoimmune dysfunction
What is fever a red flag for
Risk of systemic infection
What is pain unrelated to activity a red flag for
Risk of referred pain from visceral source
What is pain not relieved by rest a red flag for
Risk of referred pain from visceral source
What is a history of smoking a red flag for
Risk of lung cancer and referred pain from cardiac system
What is previous hx of cancer a red flag for
Risk of referral of pain and/or metastasis
What is cardiac risk factors a red flag for
Myocardial infarction refer to left shoulder
What is pleuritic pain a red flag for
Risk of pancoast tumor
What are the 5 types of extrinsic causes of shoulder pain
- Neurological
- Cardiovascular
- Pulmonary
- Malignancy
- Abdominal
What are sources of neurological symptoms (5)
- Cervical radiculopathy
- Upper trunk brachial plexopathy
- Neurologic amyotrophy
- Focal mononeuropathy
- Muscular dystrophy
What are sources of cardiac pain (4)
- Cardiac ischemia
- TOS
- Aortic disease
- Axillary dsytrophy
What are sources of pulmonary pain (4)
- Upper lobe pneumonia
- Pulmonary embolism
- Pneumothorax
- Pneumoperitoneum
What are sources of malignancy (2)
- Pancoast tumor
2. Metastatic cancer
What are sources of abdominal pain (5)
- Biliary disease
- Hepatic disease
- Pancreatitis
- Splenic injury
- Perforated viscus
What should you ask about a FOOSH
Which way they fell and the position of their arms
What is a sclerotome
Deep somatic tissue (bone)
What does shifting or popping out signify
Instability
What does clicking, snapping, or grinding signify
Wear ant tear, labral tear
What does an ache signify
Muscle
What does a sharp pain signify
Nerve
What does stiffness signify
Capsule, DJD, effusion
What does burning signify
Nerve
What does dead arm signify
TOS
What is DeJourne’s Triad
Sneezing, coughing, straining
What does laying on shoulder/night pain signify
Muscular, hypermobility
What does reaching overhead pain signify
Impingement, tendinitis, Spur on acromion
What does washing back of head pain signify
Inferior capsule tight
What does applying deodorant pain signify
Instability, impingement
What does reaching for wallet pain signify
Adhesive capsulitis, subscapularis strain/tear
What does reaching into backseat of car pain signify
Anterior instability, posterior impingement, biceps tendinitis
What does pushing open door pain signify
Posterior capsule instability
What does pushing up from chair pain signify
AC joint problem
What does getting change at toll pain signify
Impingement of lack of strength
What does overhand throwing pain signify
Have to know where symptoms are
Where do the origin of symptoms come from with DeJourne’s Triad
Space occupying lesion
What is a rare genetic disorder of collagen disorder that have deficit in development of collagen and is life threatening
Ehlers-Danlos (ED)
What are people with Ehlers-Danlos at higher risk of
RA or JRA
True or False:
People with Ehlers-Danlos are usually hypermobile
True
What is an autosomal dominat genetic disorder of CT, disproportionate long pibs, fingers, tall structure, pectus excavatum and predisposed to CV disorders
Marfan’s Syndrome
What is pectus excavatum
Sternum is concave into chest
Pt reports of lateral shoulder pain with overhead
activities or demonstration of painful arc (diagnosis)
AC joint, bursitis, tendinitis, or subacromial impingement
Pt reports instability, apprehension, and pain with
activities most often when shoulder is ABDed and ERed (diagnosis)
Anterior instability and possible labral tear (if blocking is present)
Decreased ROM and pain with resistance (diagnosis)
Possible RC or long head of biceps tendinitis/tear
Pt reports of pain and weakness with muscle loading,
night pain. Age > 60 (diagnosis)
Possible RC tear
Pt complaints of poorly located shoulder pain with
occasional radiation into elbow. Pain usually
aggravated by movement and relieved by rest. Age >
45. Females more affected than males (diagnosis)
Possible adhesive capsulitis
Pt reports of a fall on the shoulder followed by pain
over AC joint (diagnosis)
Possible AC sprain
Pt complaints of UE heaviness or numbness with
prolonged postures and when lying on involved side (diagnosis)
TOS
