Shoulder Functional/Special Tests Flashcards
DDx of Shoulder Pain
-Impingement/RC
-Adhesive Capsulitis
-GH instability
-Post op
-Serious Cause
Observations
-Posture
-Willingness to move
-Shoulders level: atrophy, flattening of deltoid (ant dislocation)
-Scapula: winging or deformities
-Dominant arm: lower shoulder
-Muscle spasms, wasting
Contraindications for Manual Therapy
-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated
UQ Scan
- Vitals (HR and BP)
- CNs (optional)
- Observation: posture, plumb line, head, face, neck, mouth
- Gait: look for gross abnormalities
- Clear the spine
- UE ROM: All 6 w/ overpressure
- Dermatomes (C4-T2)
- Myotomes (C5-T1)
- DTR: bicep, brachioradialis, tricep
- UMN Testing: Hoffman’s, Babinski, Lhermitte
- Upper Limb Tension Testing (Median)
- Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
- Thyroid (optional)
- Lymph Nodes (neck, and axilla) (optional)
Median Nerve ULTT 1
- Use elbow to depress scap
- Abduct
- Extend wrist and fingers
- ER
- Elbow extension
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
Contraindications for Neurodynamic Mobilizations
-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders
Radial Nerve ULTT 2
- Use hand to depress scap
- GH IR
- Flexion wrist and fingers
- Forearm pronation
- Elbow extension
- GH ABD
- Lat sidebending
+ Findings: differences btw sides, distant component, reproduction of s/s
Ulnar Nerve ULTT 3
- Use hand to depress scap
- Abduct
- GH ER
- Forearm pronation
- Extend wrist and fingers
- Elbow flexion
- Lat side bending
+ Findings: differences btw sides, distant component, reproduction of s/s
Shoulder AROM Exam
-Flexion/IR and ER @0/ABD for everyone
-Ext/Horizontal (cross arms)
overpressure if pain-free
Resisted test in mid-range EVEN if painful
Shoulder Resisted ROM
-hold for 5s
Flx: at wrist
ABD: elbows bent
IR/ER: bent elbows and push at wrist
Strong; painless
Strong; painful
Weak; painless
Weak; painful
Painful Arc Sign
-RC pathology indicator
-impingement test
-Pain in mid-range
GH: 60-120 pain
-max stress on subacromial space
AC: end range pain
-max stress on AC
Scapular Dyskinesis Test
-altered scapular position and motion
-only check if seen during ROM
-changes GH loads
- Pt raises and lowers BIL 3-5x
-if needed inc reps or weight
(+) obvious deformity
SICK Scapula: Malposition of scap, inferior medial boarder, coracoid pain and malposition, scapular dykinesia
GH Distraction Mobilization/Assessment
-all parts of joint
- Pt in supine
- Pt arm to side with elbow above shoulder in OP
- Provide distraction (sustained or oscillatory)
GH Inferior Glide Mobilization/Assessment
-abduction
- Pt in supine
- Pt arm to side with elbow above shoulder in OP
- Use arm crotch on superior humeral head (sustained or oscillatory)
GH Anterior Glide Mobilization/Assessment
-Extension and external rotation, horizontal ABD
- Pt in prone w/ arm off side
- Pt elbow below shoulder
- Provide anterior force to humerus
GH Posterior Glide Mobilization/Assessment
-Flexion and Internal rotation, horizontal ADD
- Pt in supine
- Pt arm to side with elbow above shoulder in OP
- Use hypothenars to push posteriorly while supporting elbow
AC Joint Mobilization/Assessment
-only if they have pain at end range OR pain at AC joint
-Superior glide: adduction/ext
-Inferior glide: Abduction/flx
- Pt in supine
- Grab clavicle closest to acromion
- Superior and Inferior glide
- Can Assess in GH elevation
SC Joint Mobilization/Assessment
-only if they have pain at SC joint
-Superior glide: ext
-Inferior glide: flx
- Pt in supine with arms at side
- Grab patients clavicle as close to sternum
- Inferior or superior glide
ST Joint Mobilization/Assessment
- Pt in sidelying
- Pt arm on PT forearm
- PT holding top and bottom of scapula
- Distraction; lift up medial boarder
-Superior/inferior/medial/lateral
Palpation
-muscles
-AC joint
-SC joint
-Clavicle
-Coracoid
-sternum
-Scap
Shoulder Impingement Tests
-provocative, 1 side only
-Neer
-Hawkins-Kennedy
-Cross-Body Adduction
-Painful Arc
Muscle/Tendon Pathology Tests
-BIL assessment
-look for weakness and pain
-Speed’s Test
-Full can
-Empty Can
-ER Lag sign
-Infraspinatus Strength
-Belly press
-Lift off Sign
-IR lag sign
-Drop Arm
Neer Test
-jam greater tuberosity hits acromion
-injury to supraspinatus and possible biceps tendon
- Pt in sitting
- PT passively IR and FLX arm
- Repeat with ER
(+): pain with IR relieved with ER
Hawkins-Kennedy Test
-supraspinatus tendinopathy
-press supra into coracoid or coraco-acromial lig
- Pt in sitting
- Arm flexed to 90 (slight H ADD) with elbow bent
- PT forces into IR
(+): pain
Cross-Body Adduction Test
-AC joint pathology
- Pt in sitting
- PT elevates to 90 and Horizontally ADD to end range
(+): subacromial pain
Speed’s Test
-long head of bicep tendinopathy
- Pt flexion at shoulder level, elbow extended, forearm supinated
- PT push on wrist
(+): pain in bicipital groove
Full Can Test
-done first, less provocative, then Empty Can
-Supraspinatus tendinopathy
- Pt sitting
- Arms scaption, ER, thumbs up
- PT pushes on wrists
(+): weakness and reproduction of s/s
Empty Can test
-done 2nd after positive Full Can
-Supraspinatus tendinopathy
- Pt sitting
- Arms scaption, IR, thumbs down
- PT pushes on wrists
(+): weakness and reproduction of s/s
Infraspinatus Strength test
-infraspinatus strength
- Pt holds arm out 45 deg in scapular plane
- PT holds elbow and pushes into ER witht resistance
(+): Pt cannot resist due to pain or weakness
ER Lag Sign
-infraspinatus tear
- Pt holds arm out 45 deg in scapular plane
- PT holds elbow and puts them in ER and ask to hold positTion before releasing
(+): Pt cannot hold position; infra tear
Belly Press Test (Napoleon Sign)
-subscapularis tendinopathy or tear
- Pt sits with hand across belly
- PT grabs Pt wrist and ttries to pull away from belly
(+): Pt hands moves away or elbow moves posteriorly to compensate
Lift-Off Test
-subscapular pathology
- Pt places hand on belt line and a lift away
- If capable, resist on wrist
(+): inability to do so; subscap
IR Lag Sign
-subscapular pathology
- PT places Pt hand on belt line and a lift away
- Ask Pt to hold
(+): inability to do so; large RC/subscap tear
Drop Arm Test
- PT passively lifts arm to 90 deg of ABD and ER
- Ask Pt to hold in space and let go
(+): Pt unable to maintain arm; significant RC pathology
