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517 Ortho > Shoulder Lab > Flashcards

Shoulder Lab Flashcards

1
Q

GH joint mobilizations

A

anterior/posterior
distraction: distract humerus out of joint
inferior: press down towards feet

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2
Q

Scapula joint mobilizations

A

lateral/medial
inferior
distraction: hold under medial border, pull from ribcage

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3
Q

AC joint play

shoulder position

A

stand behind pt
shoulder in 20 degrees of abduction for loose pack
fix acromion with pincer grip
translate clavicle ant/post

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4
Q

SC joint play

A

superior and inferior glides
use dummy thumb for superior glide

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5
Q

tests for GH anterior instability

A

apprehension test
relocation test

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6
Q

apprehension test

A

purpose: identify anterior labral instability
supine
90 abd
move shoulder into full ER
positive: apprehension to movement, resistance to movement; more so than pain

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7
Q

relocation test

A

purpose: identify anterior labral instability
apprehension test position
go to just before point of apprehension
apply posterior translation to humeral head
positive: decreased apprehension/pain

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8
Q

tests for GH posterior/inferior instability

A

Jerk test
sulcus sign

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9
Q

jerk test

A

purpose: identify posteroinferior labral stability
position: pt seated, shoulder 90 abd, IR
movement: PT behind pt, hold elbow and scapula superiorly
push GH backwards and adduct arm
positive: sharp posterior shoulder pain, may have clunk

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10
Q

sulcus sign

A

purpose: GH posteroinferior instability
position: standing, 20-30 shoulder abd
movement: PT pulls humerus inferiorly
positive: depression between acromion and humeral head

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11
Q

SAPS testing cluster

A

Hawkins Kennedy
Neer
Painful Arc
Full/empty can
ER iso at 90

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12
Q

SAPS test psychometrics for diagnosis

A

3/5 + tests = 2.93 likelihood ratio
<3 + tests = -.34 likelihood ratio

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13
Q

Hawkins Kennedy test

A

purpose: SAPS, ACJ
position: 90 shldr flexion, 90 elbow flexion
PT places their arm under testing side and hand onto opposite shoulder
action: compress humerus into glenoid, passive humerus IR
positive: familiar pain

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14
Q

Neer impingement test

A

purpose: SAPS
position: seated
PT stands behind pt and stabilizes scap with downward force
action: passive IR, flex shoulder through entire PROM
positive: familiar pain

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15
Q

Painful Arc

A

purpose: SAPS
position: standing
action: pt AROM in abduction, report stop and start of pain
positive: 60-120 painful - GH involvement; >170 painful, ACJ involvement

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16
Q

Full can

A

purpose: SAPS, RCRPS
position: standing/seated, arm in scapular plane at shoulder height
action: apply downward force in scapular plane as pt resists
positive: familiar pain/weakness
*should be less provocative than empty can

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17
Q

Empty Can/Jobe

A

purpose: SAPS, supraspinatus tear, impingement, suprascapular n involvement, RCRPS
position: seated, shoulder at 90 degrees in scapular plane, shoulder IR
action: resist downward force
positive: familiar pain in supraspinatus, weakness

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18
Q

Resisted shoulder ER

A

purpose: SAPS, infraspinatus tear test
position: seated
action: test BL ER MMT
positive: weakness compared to unaffected side

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19
Q

RCRPS (rotator cuff related pain syndrome) test cluster

A

Jobe/Empty Can
Full Can
ER lag sign

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20
Q

Meaning of negative full can and positive empty can

A

pain is primarily related to a rotator cuff lesion

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21
Q

Unable to distinguish ________ or _________ with Empty Can test

A

rotator cuff dysfunction or impingement

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22
Q

ER lag sign

A

purpose: RCRPS - infraspinatus or supraspinatus pathology
position: passive 20 shldr abd in scapular plane, elbow flexed, full ER - ~5 degrees
action: pt holds as PT releases arm, supporting only elbow
positive: pt is not able to hold max ER in this position, will move into IR

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23
Q

Full thickness infraspinatus tear testing

A

ER lag sign

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24
Q

Full thickness subscapularis testing

A

lift off test
belly press
bear hug

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25
Q

lift off test

A

purpose: subscapularis lesion
position: standing, hand in small of back
action: pt lifts hand off back
positive: pt is unable or aberrant scapular movement

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26
Q

Belly press test

A

purpose: subscapularis tear
position: standing/seated?, PT has hand on pt belly with pt’s hand pressing in
action: pt presses into belly/PT hand as PT resists their IR
positive: weakness or pain
*quantify weakness w pressure cuff instead of hand

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27
Q

bear hug test

A

purpose: subscapularis lesion
position: seated
action: pt places hand on opposite shoulder w arm at 90 degrees, pt presses their hand down into the shoulder
positive: pain

28
Q

rotator cuff tendinopathy/partial tear testing

rule out w what tests?

A

painful arc
Hawkins Kennedy
these 2 being negative used to rule out diagnosis

If these tests are negative it is unlikely pt has RC tendinopathy

29
Q

IR lag sign

A

purpose: rule out full thickness subscapularis tear
position: standing/seated, PT passively moves pts hand behind back and lifts hand off lumbar spine
action: pt maintains forearm position as PT releases them while supporting the elbow
positive: unable to maintain position, falls back towards back

30
Q

Additional tests for full thickness RC tear

A

drop arm
hornblower’s sign

31
Q

Drop arm test

A

purpose: full thickness RC tear/supraspinatus specifically
position: seated, shldr abducted to 120 passively
action: pt slowly lowers arm to side as PT guards
positive: unable to control lowering of arm to side

32
Q

Hornblower’s sign

A

purpose: full thickness RC tear, teres minor or infra
position: seated, passive abd to 90 scapular plane, elbow flexed
action: PT pushes pt into IR and pt resists, pushing into ER
positive: inability of pt to ER in this position, or forearm drops/elbow up

33
Q

ACJ testing cluster

A

Paxinos sign
active compression test
Hawkin’s Kennedy
2/3 indicates ACJ involvement?
+ horizontal adduction test for AC joint OA, laxity, separation

34
Q

Order of ACJ cluster testing

A

Paxino first
if positive: perform active compression test
if negative: perform Hawkins Kennedy

35
Q

Paxinos sign

A

purpose: ACJ involvement
position: seated, arm relaxed at side
action: PT places thumb posterolateral acromion and fingers on clavicle; apply pressure ant/superior direction with hand, fingers apply in inferior direction
positive: local ACJ pain

36
Q

Active compression/O’Brien test

A

purpose: ACJ cluster if positive paxinos, SLAP (felt inside shoulder)
position: seated, shoulder flexed to 90, 10 degrees h. add. (hands together)
action: apply downward pressure with shoulder IR, then ER
positive: IR provoking pain/click, ER relieving
* pain location at AC joint or inside GH

37
Q

SLAP (superior labrum anterior to posterior) testing

A

Active compression/O’Brien’s: with symptoms inside shoulder
Passive distraction

38
Q

Passive distraction test

A

purpose: SLAP lesion
position: supine, 150 abd, forearm supinated
action: PT stabilizes arm and pronate forearm
positive: pain deep in ant or post GH joint

39
Q

SLAP lesion testing with weak clinical value

A

bicep load I test
bicep load II test
Crank test
Anterior Slide test
Yergason
Speed’s

40
Q

Bicep load I test

A

purpose: SLAP
position: position of apprehension test, 90 abd full ER in supine
action: apply resistance to elbow flexion
positive: apprehension same or worse + pain

41
Q

Bicep load II test

A

purpose: SLAP
position: supine, shldr abd 120, 90 elbow flexion, forearm supination
action: flex elbow against resistance
positive: pain

42
Q

Crank test

A

purpose: SLAP
position: supine, shldr abd 120
action: provide axial compression to GH from humerus or elbow while repeating IR then go into ER
positive: pain, click, catching
*similar to McMurrays for knee

43
Q

Anterior slide test

A

purpose: SLAP
position: seated, hands on waist, thumbs posterior
action: apply anterior superior pressure at elbow as patient resists, stabilize scapula with other hand
positive: pain, click deep in shoulder

44
Q

Yergason’s test

A

purpose: integrity of transverse ligament (bicep tendon) bicipital tendinosis, SLAP
position: seated, 90 elbow flexion, forearm pronated
action: palpate bicipital groove, pt resists supination of forearm
positive: pain/tender without popping indicates tendinopathy or SLAP, popping indicates torn transverse humeral ligament

45
Q

Speed’s test

A

purpose: SLAP, bicipital tendinosis
position: elbow extended, forearm supinated
action: pt performs AROM flexion to 90, then resist shldr flexion
positive: pain/tender in bicipital groove

46
Q

ULTT 1

A

purpose: identifies peripheral nerve dysfunction, median bias
position: supine, depressed shoulder girdle
action: abd 110, ER, forearm supination, then extend elbow, wrist, and fingers
positive: reproduction of symptoms, side to side diff of 10 degrees, CL SB increases symptoms and IL SB decreases symptoms

47
Q

thoracic outlet syndrome tests

A

adson’s test
roos test

48
Q

Adson’s test

A

purpose: thoracic outlet, vascular component
position: seated, arms 15 deg abd, inhale deeply and hold breath, tilt head back and rotate towards testing side
action: PT checks pulses before and during
positive: change in pulse, paresthesia

49
Q

Roos test

A

purpose: thoracic outlet
position: seated, arms 90 abd, 90 elbow flexion
action: pt does slow finger clenching for 3 min
positive: unable to maintain position, pain, heaviness, N/T, disappearance of pulse

50
Q

Frozen shoulder testing

A

ROM limitations in capsular pattern (PROM), compare to unaffected side
1. ER (loss of 50% or <30 degrees)
2. Abd 25% loss of motion
3. Flexion 25% loss of motion

51
Q

Scapulothoracic special tests

A

lateral scapular slide test
dynamic scapular dyskinesias

52
Q

lateral scapular slide test

A

distance of inferior angle from spinous process with arms at side, hands on hips, arms at 90
positive: 1.5+ cm difference between sides

53
Q

dynamic scapular dyskinesia testing

A

active flexion/abduction with small weight
positive: medial border winging, inferior angle winging, dysrhythmia including premature shoulder elevation, non symmetrical upward rotation, rapid descent

54
Q

subscapularis stretch

A

retract scap with fingers under medial border
pin humerus back with towel/body
pull scapula away from body
perform if limited ER with arms at side
ther ex: active ER, abduction w ER

55
Q

levator stretch

A

1 hand superior scap, 1 inferior
rotate scapula upwards and pull inferior angle away from body
ther ex: levator stretch w arm behind head

56
Q

shoulder close pack

A

90 abd
full ER
or full abd and ER

57
Q

shoulder open pack

A

55 abd, 30 h. add

58
Q

shoulder capsular pattern

A

ER>abd>IR

59
Q

name of types of scapular dysfunction

A

Kibler types

60
Q

Kibler type 1

A

inferior medial border is more prominent

61
Q

causes of kibler type 1

A

results from anterior tilt of scapula
tight pec minor/biceps SH
LT, lat, serratus weakness

62
Q

kibler type 2

A

medial border off of ribs
worse w hands on hips
glenoid fossa pointed anterior straining anterior capsule

63
Q

cause of kibler type 2

A

serratus and LT weakness

64
Q

kibler type 3

A

superior border of scapula elevated

65
Q

causes of kibler type 3

A

tight UT
weak LT

517 Ortho (11 decks)

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