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Shoulder Functional/Special Tests Flashcards

1
Q

DDx of Shoulder Pain

A

-Impingement/RC
-Adhesive Capsulitis
-GH instability (Labral/Slap)
-Post op
-Serious Cause
-Scapular Instability
-AC/SC Joint

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2
Q

Shoulder Pain DDx: Rotator Cuff/Impingement

A

(+):
-impingement signs
-painful arc
-pain w/ iso resistance (tendinopathy) (mid range)
-weakenss
-atrophy

(-):
-significant loss of motion
-instability signs

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3
Q

Shoulder Pain DDx: Frozen shoulder

A

(+):
-spontaneous progressive pain
-loss of motion in multiple planes
-pain at end range

(-):
-normal motion
-<40 yrs

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4
Q

Shoulder Pain DDx: GH Instability

A

(+):
-<40 year
-Hx of dislocations
-Apprehension
-Laxity

(-):
-No hx of dislocations
-No apprehension

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5
Q

Observations

A

-Posture
-Willingness to move
-Shoulders level: atrophy, flattening of deltoid (ant dislocation)
-Scapula: winging or deformities
-Dominant arm: lower shoulder
-Muscle spasms, wasting

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6
Q

Contraindications for Manual Therapy

A

-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

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7
Q

UQ Scan

A
  1. Vitals (HR and BP)
  2. CNs (optional)
  3. Observation: posture, plumb line, head, face, neck, mouth
  4. Gait: look for gross abnormalities
  5. Clear the spine
  6. UE ROM: All 6 w/ overpressure
  7. Dermatomes (C4-T2)
  8. Myotomes (C5-T1)
  9. DTR: bicep, brachioradialis, tricep
  10. UMN Testing: Hoffman’s, Babinski, Lhermitte
  11. Upper Limb Tension Testing (Median)
  12. Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
  13. Thyroid (optional)
  14. Lymph Nodes (neck, and axilla) (optional)
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8
Q

Median Nerve ULTT 1

A
  1. Use elbow to depress scap
  2. Abduct
  3. Extend wrist and fingers
  4. ER
  5. Elbow extension
  6. Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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9
Q

Contraindications for Neurodynamic Mobilizations

A

-Recent repair
-Malignancy
-Active Inflammatory Disorders
-Acute Inflammatory Demyelinating Disorders

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10
Q

Radial Nerve ULTT 2

A
  1. Use hand to depress scap
  2. GH IR
  3. Flexion wrist and fingers
  4. Forearm pronation
  5. Elbow extension
  6. GH ABD
  7. Lat sidebending

+ Findings: differences btw sides, distant component, reproduction of s/s

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11
Q

Ulnar Nerve ULTT 3

A
  1. Use hand to depress scap
  2. Abduct
  3. GH ER
  4. Forearm pronation
  5. Extend wrist and fingers
  6. Elbow flexion
  7. Lat side bending

+ Findings: differences btw sides, distant component, reproduction of s/s

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12
Q

Shoulder AROM Exam

A

-Flexion/IR and ER @0/ABD for everyone
-Ext/Horizontal (cross arms)

overpressure if pain-free
Resisted test in mid-range EVEN if painful

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13
Q

Shoulder Resisted ROM

A

-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

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14
Q

Painful Arc Sign

A

-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

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15
Q

Scapular Dyskinesis Test

A

-altered scapular position and motion
-only check if seen during ROM
-changes GH loads

  1. 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

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16
Q

GH Distraction Mobilization/Assessment

A

-all parts of joint

  1. Pt in supine
  2. Pt arm to side with elbow above shoulder in OP
  3. Provide distraction (sustained or oscillatory)
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17
Q

GH Inferior Glide Mobilization/Assessment

A

-abduction

  1. Pt in supine
  2. Pt arm to side with elbow above shoulder in OP
  3. Use arm crotch on superior humeral head (sustained or oscillatory)
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18
Q

GH Anterior Glide Mobilization/Assessment

A

-Extension and external rotation, horizontal ABD

  1. Pt in prone w/ arm off side
  2. Pt elbow below shoulder
  3. Provide anterior force to humerus
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19
Q

GH Posterior Glide Mobilization/Assessment

A

-Flexion and Internal rotation, horizontal ADD (FIADD)

  1. Pt in supine
  2. Pt arm to side with elbow above shoulder in OP
  3. Use hypothenars to push posteriorly while supporting elbow
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20
Q

AC Joint Mobilization/Assessment

A

-only if they have pain at end range OR pain at AC joint
-Superior glide: adduction/ext
-Inferior glide: Abduction/flx

  1. Pt in supine
  2. Grab clavicle closest to acromion
  3. Superior and Inferior glide
  4. Can Assess in GH elevation
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21
Q

SC Joint Mobilization/Assessment

A

-only if they have pain at SC joint
-Superior glide: ext
-Inferior glide: flx

  1. Pt in supine with arms at side
  2. Grab patients clavicle as close to sternum
  3. Inferior or superior glide
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22
Q

ST Joint Mobilization/Assessment

A
  1. Pt in sidelying
  2. Pt arm on PT forearm
  3. PT holding top and bottom of scapula
  4. Distraction; lift up medial boarder
    -Superior/inferior/medial/lateral
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23
Q

Palpation

A

-muscles
-AC joint
-SC joint
-Clavicle
-Coracoid
-sternum
-Scap

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24
Q

Shoulder Impingement Tests

A

-provocative, 1 side only

-Neer
-Hawkins-Kennedy
-Cross-Body Adduction
-Painful Arc

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25
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
26
Neer Test
-jam greater tuberosity hits acromion -overuse or injury to supraspinatus and possible biceps tendon 1. Pt in sitting 2. PT passively IR and FLX arm 3. Repeat with ER (+): pain with IR relieved with ER
27
Hawkins-Kennedy Test
-supraspinatus tendinopathy -press supra into coracoid or coraco-acromial lig 1. Pt in sitting 2. Arm flexed to 90 (slight H ADD) with elbow bent 3. PT forces into IR (+): pain
28
Cross-Body Adduction Test
-AC joint pathology 1. Pt in sitting 2. PT elevates to 90 and Horizontally ADD to end range (+): subacromial pain
29
Speed's Test
-long head of bicep tendinopathy 1. Pt flexion at shoulder level, elbow extended, forearm supinated 2. PT push on wrist (+): pain in bicipital groove
30
Full Can Test
-done first, less provocative, then Empty Can -Supraspinatus tendinopathy 1. Pt sitting 2. Arms scaption, ER, thumbs up 3. PT pushes on wrists (+): weakness and reproduction of s/s
31
Empty Can test
-done 2nd after positive Full Can -Supraspinatus tendinopathy 1. Pt sitting 2. Arms scaption, IR, thumbs down 3. PT pushes on wrists (+): weakness and reproduction of s/s
32
Infraspinatus Strength test
-infraspinatus strength 1. Pt holds arm out 45 deg in scapular plane 2. PT holds elbow and pushes into ER witht resistance (+): Pt cannot resist due to pain or weakness
33
ER Lag Sign
-infraspinatus tear 1. Pt holds arm out 45 deg in scapular plane 2. PT holds elbow and puts them in ER and ask to hold positTion before releasing (+): Pt cannot hold position; infra tear
34
Belly Press Test (Napoleon Sign)
-subscapularis tendinopathy or tear 1. Pt sits with hand across belly 2. PT grabs Pt wrist and ttries to pull away from belly (+): Pt hands moves away or elbow moves posteriorly to compensate
35
Lift-Off Test
-subscapular pathology 1. Pt places hand on belt line and a lift away 2. If capable, resist on wrist (+): inability to do so; subscap
36
IR Lag Sign
-subscapular pathology 1. PT places Pt hand on belt line and a lift away 2. Ask Pt to hold (+): inability to do so; large RC/subscap tear
37
Drop Arm Test
1. PT passively lifts arm to 90 deg of ABD and ER 2. Ask Pt to hold in space and let go (+): Pt unable to maintain arm; significant RC pathology
38
Shoulder Hx: Subjective
-Pain (duration, quality and behavior/other pain) -Neck/back issues -Movement issues -MOI (traumatic/overuse/change in activities) -Work -Handedness -Aggs/Eases -Duration -Age
39
Shoulder Hx: Age
Children: Cancer or epiphysis 10-20s: instability then secondary imingement 20:40: calcium depositis 40-60: RC or frozen shoulder
40
Shoulder Hx: MOI
Overheard Exertion/Repetitive: -Subacromiial -RC tear -Biceps tendinopathy FOOSH: -Fx -AC Joint separation -GH Dislocations Fall on Tip of Shoulder: -AC Joint separation -C-spine Forced Horizontal ABD/est/ER -anterior dislocation Swimmers: -Fatigue of muscles -impaired stability
41
Shoulder Hx: Pain Relief
W/ Elevation: -C-spine W/ Elbow Supported: -AC joint separation -RC tears Circumduction w/ click: -GH instability W/ Arm Distraction: -Bursitis -RC Arm in dependent position: -TOS
42
General Rehab Principles for Shoulder
1. Pt Education: -posture -ergonomics -activities to avoid 2. Proximal to Distal Tx -T spine -C soine - Shoulder
43
Specific Rehab Tools for Shoulder
1. Joint mobs 2. Mobility 3. Strengthening 4. Endurance 5. Closed Kinetic chain 6. Plyometrics
44
GH Progressive Inferior Mobilization
-lacking ABD 1. Pt supine w/ arm abd 45-90 deg 2. PT provides long axis distraction AND inferior glide 3. Repeat by increasing ABD
45
GH Progressive Flexion/ABD/ER Mobilization
-for Pt who have issues with combined motions 1. Pt prone in abd/flx/ER 2. PT uses webspace to mobe into arm pit in direction of the elbow as you move 3. Increase ABD as you go
46
GH Progressive Posterior Mobilization
1. Start in normal posterior position as close to 90 as possible 2. Increase Pt horizontal ADD and scoop out AND down 3. Increase ADD as you go
47
GH Progressive Anterior Mobilization in Prone
-frozen shoulder or significant loss of mobility of volume 1. Pt in prone 2. Towel under glenoid 3. PT distracts and mobs PA on humerus 4. Can use stool to increase ER
48
GH Progressive Anterior Mobilization in Supine
- frozen shoulder or significant loss of mobility -cannot tolerate prone 1. Pt supine with towel under humerus 2. PT distracts humerus and AP mobs at GLENOID 3. Progressively increase ER
49
GH Posterior Mobilization w/ Movement
1. Pt in sitting 2. PT on opposite side with hand on scapula and superior head 3. Have pt move with you
50
GH Inferior Mobilization w/ ER for Adhesive Capsulitis
1. Pt in supine 2. PT faces feet and holds elbow 2. PT ERs wind up of shoulder with long axis distraction
51
Shoulder Mobility
1. Pendulum 2. T Bar ER from side to side 3. T Bar Elevation 4. Wall Pulleys
52
Capsular Stretching
Anterior: -Limited ER or EXT -ER and progress with weights -don’t give if excessice anterior glide Posterior: -limited FLX or IR - Pt lays on side and brings arm across body - Progress with towel then pull hand
53
Lower Trap Strengthening
-check scapular mobility for anterior tightness 1. Pt in prone 2. PT passively into lower trap set and has Pt hold it 3. Progress to lifting past set or add weight
54
Instability Tests
-Anterior Apprehension - Jobe Relocation Test -Sulcus Sign -Posterior Apprehension Test
55
SLAP Lesion Tests
-Active Compression/O'Brien's -Biceps Load I -Biceps Load II
56
Labral Test
-Clunk Test
57
Scapular Stability Tests
-Scapular Dyskinesis Test -Scapular Assistance Test -Wall Push Up -Pec Minor Tightness
58
AC Joint Pathology Tests
-Step Deformity -Palpation -Cross-Body Adduction -Active Compression/O'Brien's Test
59
Apprehension Test
-Anterior GH instability 1. Place Pt into 90/90 with overpressure 2. Watch for Apprehension (+): apprehennsion or guarding
60
Jobe Relocatioon Test
-anterior GH instability -Only if Apprehension test (+) 1. Provide Overprssure in 90/90 and should get better (+): dec apprehension or reducttion in s/s; can ER more
61
Sulcus Sign
-Inferior or multidirectional GH instability 1. Pt seated 2. ABD arm 20-50 and provide downward force (+): sulcus sign greater than 1 finger Grade 1: 1 cm Grade 2: 1-2cm Grade 3: >2 cm
62
Posterior Apprehension Test
-posterior GH instability 1. Pt Supine or siting 2. PT stabilizes scap, horizontally ADD shoulder and proiides posterior force (+): pain in post shoulder, aprehension
63
Active Compression/O'Brien's Test
-SLAP tear OR AC Joint test -assess pain from Bicep NOT labrum 1. Pt in standing w/ arm flexed, ext, horizontally ADD and IR 2. PT aplies resisance for 5s 3. Turn to ER and do again (+): pain w/ IR that dec with ER OR over AC joint
64
Biceps Load I Test
-SLAP tear -done 1st 1. Pt in supine in 90/90 2. PT resists elbow flexion (+): reproducion of shoulder pain w/ resisted flexion
65
Biceps Load II Test
-SLAP tear -done 2nd if Bicep I not positive 1. Pt in supine in 90/120 (abd) 2. PT resists elbow flexion (+): reproducion of shoulder pain w/ resisted flexion
66
Clunk Test
-Labral pathology/ labral fragment caught in joint (=instability) 1. Pt in supine 2. PT holds humerus and forearm 3. PT abd arm fully and ER while pushing humeral head anteriorly (+): clunk or grindninng sound; may cause apprehension
67
Scapular Assistance Test
-Scapular stability/dyskinesis -oppens up subacromial space 1. Pt in standing 2. PT hands on suerior angle and inferior angle 3. Pt activiely elevates while PT helps upwardly rotates (+): dec of shoulder s/s
68
Wall/Floor Push Ups
-scapular stability 1. Pt performs 3-5 push ups 2. Can do on floor or walk outs for stronger (+): obvious muscle weakness noted (winging)
69
Pec Minor Tightness Test
-scapular stability/asymmetries (maybe ant tipping) 1. Pt supine w/ arms at side 2. PT pushes on both coracoids (+): differnces in shoulder heights
70
Presense of Step Deformity
-AC joint pathology 1. Gapping of AC joint to GH

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