Shoulder Joint Flashcards
Capsular pattern for GH
lateral rotation> abduction> medial rotation
Coracoclavicular Ligament
conoid (medial) and trapezoid (lateral) parts, control vertical motion of the clavicle, step deformity= torn
AC Ligament
runs transverse from superolateral clavicle to acromion superior
GH Ligaments
Superior limits inferior and anterior translation up to 45’, middle is missing in many people, limits lateral rotation btw 45-90, Inferior has ant and post bands with axillary pouch and supports humeral head above 90, ant band tightens with lat rot, post tightens with med rot
Coracohumeral ligament
limits inf translation and lat rot below 60 abd, btw supraspinatus and subscapularis tendons (uniting them anteriorly)
GH Rest and close packed positions
Rest: 55’ abduction, 30’ horizontal abduction
Closepacked: 90’ abduction and lateral rot
AC rest and close packed positions
rest: arm at side,
close packed: arm abducted to 90
Capsular pattern for AC
pain at any extreme of motion, esp horizontal adduction and full elevation
SC Joint description
complex joint with disc, capsule thicker ant than post,
SC Ligaments
ant and post sternoclavicular: from clavicle posteromedial to sternum
interclavicular runs on sup manubrium btw both clavicles
Costoclavicular: runs from clavicle inferomedial to 1st rib, main ligament
SC rest and closed packed
rest: arm at side,
close packed: full rortation of clavicle which occurs when arm is elevated
Apley’s Scratch Test
Pt combines medial rotation with adduction and lateral rotation with abduction, motion looks like they are scratching their back. Motion can be done in one arm at a time, both arms at same time in same direction or both arms at same time in opposite directions (gomukasana arms)
Ant Apprehension Test
Pt supine, shoulder abducted to 90, elbow flexed to 90, bring into ER and watch for reaction
Ant Drawer Test
Testing for Anterior Capsule instability
Pt supine and arm in resting position, PT applies SUP forces from INF, proximal humerus
- If head of humerus pops out, replace it with Jobe’s Relocation
Posterior Apprehension
Tests for posterior capsule instability
Pt is supine, shoulder flexed 90 , elbow flexed, PT applies posterior forces from elbow with other hand supporting posterior GH and feeling for instability
Posterior Drawer
Shoulder abducted to 55, no horizontal abduction, one arm supports the acromion/ proximal GH; the other hand is on the proximal GH, and PT applies posterior force to test for instability
Sulcus Sign
Pt is seated or standing, PT at side
- PT supports forearm with one arm, finds the GH joint with the other hand. PT applies inferior force and feels for movement at GH
Rowe Test for Multidirectional Instability
Pt stands upright, then bends at hips (similar to Codman’s), PT has one hand on distal humerus
- Ant: Use hand stabilizing scapula to apply anterior forces (behind pt)
- Post: Use hand stabilizing scapula to apply posterior forces (in front of pt)
- Inf: PT applies inf forces along distal humerus to check for inf instability
Faegin Test
Tests for Inferior Instability
Pt’s arm abducted to 90 and placed on PT’s shoulder, PT applies inferior force at superior proximal humerus
Yergason’s Test
Tests Biceps, “Hitchhike”
Pt’s elbow is flexed to 90, IR’ed, and pronated, PT resists flexion, ER, and supination at distal forearm (+) pain
Speed’s Test
Pt seated, shoulder flexed to 90, arm ERed, forearm supinate, elbow extended. PT resists isometric shoulder flexion. (Alt: arm extended in ER) (+) pain in bicipital groove
Drop Arm Test
Tests Rotator Cuff, Pt lifts arms to full abduction, then slowly lowers them to sides. If pt is able to lower, apply a tap of pressure (be ready to catch them). (+) lack of eccentric control
Supraspinatus Test
Tests Supraspinatus muscle.
Pt holds arm in IR and flexes in scapular plane <90. PT resists distal forearm. (+) pain or lack of control
Empty Can/ Full Can Test
Tests for Rotator Cuff tears, Pt holds arm in scapular plane, lifts to 90, PT resists iso. flex
Empty Can: Thumb down, GH in IR
Full Can: Thumb Up, GH in ER
- Both tests give same data, except empty can grinds soft tissue and compresses beneath acromion
(+) pain or weakness
Hawkins- Kennedy Test
Tests for impingement of soft tissue in subacromial arc.
Arm flexed to 90 in scapular plane, elbow flexed to 90, PT pushes into IR.
(+) pain 2/2 to compression
Yokum Test
Tests for impingement of soft tissue in subacromial arc.
Pt places affected hand on opposite shoulder and lifts elbow
(+) pain 2/2 to compression
Neer Test
Tests for impingement of soft tissue in subacromial arc.
Stabilize trunk, PT lifts pt’s IR’ed arm into flexion (Neer to the ear)
(+) pain 2/2 to compression
Crank Test
Test for labral tears
Pt supine or seated, arm in 160 abduction in scapular plane, elbow flexed to 90, PT stabilized shoulder and applies force into GH joint through elbow while gently rotating arm
(+) pain with ER or reproduction of cardinal sign
O’Brien’s Test
Tests for labrum tears. 2 parts, Pt flexes arm to 90, elbow extended
1- Shoulder IR’ed and horizontally adducted, PT applies inf force and pt resists
2- Same as above but with shoulder ER’ed
(+) If 1 is +, then labrum tear, if both are +, then not a labrum tear because different structures are stressed
Mimori New Pain Provocation
Pt seated, shoulder stabilized
1- PT lifts arm into 90’ abduction, full ER, elbow flexed to 90, and forearm pronated.
2- After rest, PT lifts arm to 90’ abduction, full ER, elbow flexed to 90, and forearm supinated.
(+) if 1 reveals pain because biceps tendon stretched in 1 but on slack in 2.
Biceps Load
Tests for labrum tear.
Pt supine, same as apprehension test, only add resisted isometric elbow flexion at 90’.
- (+) feeling of apprehension increases when elbow flexed
- (-) if elbow flexion relieved Sx.
SC Joint Inf Glide
Pt supine, PT’s thumbs at superomedial end, with motion in inferolateral direction, increases clavicular elevation
SC Joint Sup Glide
Pt supine, PT’s thumbs at inferior medial clavicle with motion in superomedial direction, to assist with clavicular depression
SC Joint A-P Glide
Pt supine, PT’s thumbs on proximal anterior clavicle, pressure to in posterior direction, improves clavicular retraction
SC Joint P-A Glide
Pt supine or seated, PT either uses thumb of key grip on posterior clavicle and brings clavicle anteriorly, improves protraction
AC Joint A-P Glide
Pt supine, stabilize acromion and PT mobilizes distal clavicle posteriorly, improves retraction
AC Joint P-A Glide
Pt supine or side-lying, stabilize acromion and PT glides distal clavicle anteriorly and slightly laterally
