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Sem 2 Clinical Skills > Shoulder examination > Flashcards

Shoulder examination Flashcards

1
Q

What are the aspects of a comprehensive history you need to cover?

A 
Presenting complaint
History of presenting complaint i.e. SOCRATESIA
Med/surg/medications/Allergies
Family history
Smoking/Diet/Alcohol/Exercise/Nutrition
Occupation
Relationship
Preventative health i.e. vaccines, pap smears, cancer checks
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2
Q

From which angles should you examine the shoulder?

A

Anteriorly, laterally, posteriorly and in the axilla

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3
Q

How should a patient be positioned for a shoulder exam?

A

Standing in a neutral position

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4
Q

What should you look for generally in a shoulder exam patient?

A

Distress
Posture
Use of aids
Assymetry

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5
Q

What should you look for on close examination of a shoulder?

A

Deformity/asymmetry
Swelling - presence/where it’s located, if it’s diffuse or localised
Skin changes - scars/erythema
Muscle wasting in the deltoid and scapular muscles

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6
Q

What is the “feel” pathway in a shoulder examination?

A 
Sternoclavicular joint
Along clavicle, medially to laterally
Acromioclavicular joint
Acromion
Subacromial space
Greater tuberosity of the humerus
Biceps tendon
Scapular spine
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7
Q

Where is the biceps tendon?

A

Anterior to the greater tuberosity, sitting between the greater T and the lesser T

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8
Q

What does active movement by the patient reveal?

A

Bone, joint, muscle and nerve problems

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9
Q

What does passive movement reveal?

A

If normal on passive movement, but abnormal active movement, it suggests muscle or nerve problems

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10
Q

What should you describe to an examiner when moving the patient?

A

Range of movement
Presence of pain
Presence of crepitus

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11
Q

What are the six movements of the shoulder?

A

Flexion - arm straight
Extension - arm backwards and straight
Abduction - arms out to the siders, straight
Adduction - arms across the body, arms straight
External rotation - arms 90 degrees, elbows fixed in
Internal rotation - arms 90 degrees, elbows fixed in

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12
Q

Why do you have the elbow at 90 degrees for internal and external rotation?

A

To avoid pronation and supination of the forearm giving a false impression of glenohumeral rotation

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13
Q

Which muscles does abduction test? What is the degree of movement?

A

Tests the middle deltoid, and supraspinatus although the last 60 degrees involves scapulothoracic movement –> trapezius, serratus anterior

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14
Q

Which muscles does adduction test? What is the degree of movement?

A

Pectoralis major
Latissimus dorsi
50 degrees of movement

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15
Q

Which muscles does flexion test? What is the degree of movement?

A

Anterior deltoid
Clavicular head pectoralis major
180 degrees

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16
Q

Which muscles does extension test? What is the degree of movement?

A

Latissimus dorsi
Posterior deltoid
Sternocostal head pectoralis major

17
Q

Which muscles does internal rotation test? What is the degree of movement?

A 
Pectoralis major
Latissimus dorsi
Subscapularis
Teres major
Anterior deltoid
90 degrees
18
Q

Which muscles does external rotation test? What is the degree of movement?

A

Infraspinatus
Posterior deltoid
Teres minor
65 degrees

19
Q

What should you still check for if active movement is fine?

A

Crepitus

20
Q

How do you check for crepitus?

A

Cup the shoulder with the top of your hand and gently abduct the arm

21
Q

How should you present your findings?

A 
Describe:
Range of movement
Presence of pain and when it occurred
State findings on both sides 
i.e. Full range of pain free flexion to 180 degrees bilaterally
22
Q

What do special power tests check for?

A

Integrity of tendon and muscle
Pain alone suggests tendon’s intact but inflamed
Pain and weakness suggests a tendon tear

23
Q

Which special test assesses the supraspinatus? Describe it

A

Empty can test
Arm abducted to 90 degrees, with 30 degrees of forward flexion
Internally rotate hand so thumb points to the ground
Maintain that position while you apply resistance downwards

24
Q

What does pain in the empty can test suggest?

A

Impingement/tendonitis

25
Q

What does weakness in the empty can test suggest?

A

A tear

26
Q

Which special test assesses the infraspinatus? What do positive findings suggest?

A

External rotation against resistance
Pain alone suggests tendonitis
Weakness suggests a tear

27
Q

Which special test assesses the subscapularis? Describe it

A

The ‘lift off’ test.
Patient places hand behind back with back of hand against the spine
Lift the hand off the back
Maintain position against resistance

28
Q

What do positive findings in the lift off test suggest?

A

If they cannot lift their hand off, suggests subscapularis weakness
If pain is present before or during resistance, suggests tendonitis. If weakness is present on resistance, suggests a tear

29
Q

What’s the premise of provocation tests for impingement?

A

Shoulder is placed in positions likely to stress or compress muscles and tendons.
If pain is elicited, test is positive i.e. abnormal

30
Q

Describe the Hawkin’s impingement test

A

Patient’s shoulder is abducted to 90 degrees, with 30 degrees forward flexion
Elbow is flexed 90 degrees
Examiner stabilises shoulder with one hand on the acromion, and internally rotates the patient’s shoulder using the other hand
Pain = positive test

31
Q

What does the Hawkin’s impingement test assess for?

A

It compresses structures in between the acromion and the greater tuberosity - looks for issues with the subacromial bursa and the supraspinatus tendon

32
Q

Which are the two tests used as provocation tests for impingement?

A

Hawkin’s impingement test

Empty can test

33
Q

What should you do on completing a shoulder exam?

A

Neurovascular examination of the upper limb

Examination of cervical spine and elbow

34
Q

What do you do in a neurovascular examination of the upper limb?

A

Brachial and radial pulses to assess for arterial damage & performing a neurological exam of the upper limb to look for spinal nerve root and brachial plexus damage

35
Q

Why is a cervical spine exam relevant when assessing a shoulder?

A

Pain from C spine can radiate to the shoulder and upper arm along C3-7 dermatomes, and masquerade as shoulder pain

36
Q

What is the relevance of examining the elbow in a shoulder exam?

A

Loss of function in the elbow may be causing the patient to immobilise the shoulder to protect the elbow - can look like shoulder dysfunction
In addition, if one joint in injured, the adjacent joint may also be injured

Sem 2 Clinical Skills (3 decks)

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