Shoulder Joint

Question 1

Capsular pattern for GH

Answer 1

lateral rotation> abduction> medial rotation

Question 2

Coracoclavicular Ligament

Answer 2

conoid (medial) and trapezoid (lateral) parts, control vertical motion of the clavicle, step deformity= torn

Question 3

AC Ligament

Answer 3

runs transverse from superolateral clavicle to acromion superior

Question 4

GH Ligaments

Answer 4

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

Question 5

Coracohumeral ligament

Answer 5

limits inf translation and lat rot below 60 abd, btw supraspinatus and subscapularis tendons (uniting them anteriorly)

Question 6

GH Rest and close packed positions

Answer 6

Rest: 55’ abduction, 30’ horizontal abduction
Closepacked: 90’ abduction and lateral rot

Question 7

AC rest and close packed positions

Answer 7

rest: arm at side,

close packed: arm abducted to 90

Question 8

Capsular pattern for AC

Answer 8

pain at any extreme of motion, esp horizontal adduction and full elevation

Question 9

SC Joint description

Answer 9

complex joint with disc, capsule thicker ant than post,

Question 10

SC Ligaments

Answer 10

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

Question 11

SC rest and closed packed

Answer 11

rest: arm at side,

close packed: full rortation of clavicle which occurs when arm is elevated

Question 12

Apley’s Scratch Test

Answer 12

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)

Question 13

Ant Apprehension Test

Answer 13

Pt supine, shoulder abducted to 90, elbow flexed to 90, bring into ER and watch for reaction

Question 14

Ant Drawer Test

Answer 14

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

Question 15

Posterior Apprehension

Answer 15

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

Question 16

Posterior Drawer

Answer 16

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

Question 17

Sulcus Sign

Answer 17

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

Question 18

Rowe Test for Multidirectional Instability

Answer 18

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

Question 19

Faegin Test

Answer 19

Tests for Inferior Instability

Pt’s arm abducted to 90 and placed on PT’s shoulder, PT applies inferior force at superior proximal humerus

Question 20

Yergason’s Test

Answer 20

Tests Biceps, “Hitchhike”

Pt’s elbow is flexed to 90, IR’ed, and pronated, PT resists flexion, ER, and supination at distal forearm (+) pain

Question 21

Speed’s Test

Answer 21

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

Question 22

Drop Arm Test

Answer 22

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

Question 23

Supraspinatus Test

Answer 23

Tests Supraspinatus muscle.

Pt holds arm in IR and flexes in scapular plane <90. PT resists distal forearm. (+) pain or lack of control

Question 24

Empty Can/ Full Can Test

Answer 24

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

Question 25

Hawkins- Kennedy Test

Answer 25

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

Question 26

Yokum Test

Answer 26

Tests for impingement of soft tissue in subacromial arc.
Pt places affected hand on opposite shoulder and lifts elbow
(+) pain 2/2 to compression

Question 27

Neer Test

Answer 27

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

Question 28

Crank Test

Answer 28

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

Question 29

O’Brien’s Test

Answer 29

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

Question 30

Mimori New Pain Provocation

Answer 30

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.

Question 31

Biceps Load

Answer 31

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.

Question 32

SC Joint Inf Glide

Answer 32

Pt supine, PT’s thumbs at superomedial end, with motion in inferolateral direction, increases clavicular elevation

Question 33

SC Joint Sup Glide

Answer 33

Pt supine, PT’s thumbs at inferior medial clavicle with motion in superomedial direction, to assist with clavicular depression

Question 34

SC Joint A-P Glide

Answer 34

Pt supine, PT’s thumbs on proximal anterior clavicle, pressure to in posterior direction, improves clavicular retraction

Question 35

SC Joint P-A Glide

Answer 35

Pt supine or seated, PT either uses thumb of key grip on posterior clavicle and brings clavicle anteriorly, improves protraction

Question 36

AC Joint A-P Glide

Answer 36

Pt supine, stabilize acromion and PT mobilizes distal clavicle posteriorly, improves retraction

Question 37

AC Joint P-A Glide

Answer 37

Pt supine or side-lying, stabilize acromion and PT glides distal clavicle anteriorly and slightly laterally