Shoulder lab Flashcards
What special tests happen during AROM?
Painful arc sign
scapular dyskinesis test
painful arc sign implies _________
pain between __________ degrees
impingement or RC pathology
60-120 degrees
How do we overpressure IR and ER?
Hand on hip/stomach with elbow bent and overpressure at elbow while keeping hand still
if we find a deficit in AROM, what do we do next
measure AROM and check passive aswell
What are the 4 measurements we take for all shoulders
Flex, ABD, IR, ER
if they have pain with specific movement we might measure that too (Ext or horizontal add or abd)
How to perform scapular dyskinesis test?
Have them elevate both arms at same time, if you have to squint it’s not there!
Obvious or normal
need 10+ reps and might need to add weight (3-5lbs)
What is the SICK scapula sign?
Malposition of (S)capula
(I)nferior medial border
(c)oracoid w/ pain and malposition
scapular dis(k)inesia
Limits in AROM but not PROM suggests what
muscular involvement
If there is a deficit but AROM = PROM, what could this mean
capsular involvement
how much ROM is needed for brushing hair
30-70 degrees horiz-add
105-120 abd
90 ER
an inferior glide of the GH is for what?
A posterior glide is for what?
Abduction
Flexion, IR
the elbow needs to be in what position relative to the body to perform GH joint play
above the body
In what 2 scenarios will you assess AC jointplay
Pain at end of shoulder elevation
or
pain at AC joint
(Don’t assess if person cannot get their arm to end of shoulder elevation in first place)
When should we check sternoclavicular joint play
if there’s pain in that region
When should we assess scapulo-thoracic joint play?
Posterior shoulder pain, they’ve been immobile in a sling, or they had scapular dyskinesis
note: no capsule here to test
Neer’s test tests for what?
what are the 2 arm positions in this test?
What is a positive sign?
impingement
ER + forceful elevation
followed by
IR with forceful elevation
Positive sign if less pain with ER
Neers test specifically indicates an overuse injury to what 2 possible structures
supraspinatus tendon
or
biceps tendon
how do you perform the hawkins kennedy test
what position do you start in
what does a positive test mean
Abd arm to 90 degrees with elbow bent, forcibly IR the shoulder, test in different degrees of horizontal adduction
start with arm by side and work your way to arm in front of body
positive test indicates supraspinatus tendinopathy
how do you perform the cross body adduction test?
what are the 2 possible positive signs?
Pt elevates arm to 90 degrees, examiner forcefully horizontally adducts arm to end range
pain at subacromial space = impingement
pain at AC joint = AC joint pathology
How do you perform speeds test?
What muscle is it testing?
positive test is what?
Examiner resists forward shoulder flexion w/ pt elbow fully extended and forearm supinated
biceps long head tendon
increased tenderness at bicipital groove = biceps tendinopathy
If a special test for the shoulder includes weakness as a positive condition, what must you do?
compare both sides
For what special tests must you test both sides
empty can test
full can test
infraspinatus test
Belly press test
Which would you do first: empty can test or full can test?
Full can test before empty can test
how to perform the full can test?
break test from this position (shoulder ER)
weakness or pain reproduced could indicate supraspinatus tendinopathy
how to perform the empty can test?
break test from this position (shoulder IR)
weakness or pain reproduced could indicate tendinopathy
What tests are for muscle TEARS?
ER lag sign
IR lag sign
Drop arm test
how to perform the infraspinatus test?
bring arm out to 45 degrees in scapular plane, maintain ER against resistance
positive test = cannot hold against ER d/t pain or weakness
infraspinatus tendinopathy
how to perform the ER lag sign?
same position as infraspinatus test (out at 45 degrees in scapular plane)
Pt is asked to hold position and examiner releases wrist
if pt arm drops and cannot resist gravity = infraspinatus tear
What muscle is the belly press test for?
how to preform?
subscapularis
Pt puts hand on belly, you try to pull hand away from belly
positive test = any compensatory movement or unable to keep hand there
infraspinatus tear/tendinopathy
how to preform the lift off test?
What muscle is it for?
For subscap
Pt attempts to lift hand off from behind back and resist manual resistance
unable = subscap pathology
note: invalid test if pt cannot get to position (do belly press test instead)
how to preform the IR lag sign test?
Same as lift off test but there is no manual resistance, they just have to hold the position
inability to do so= subscap tear
What test is for detecting large to massive RTC tears?
Drop arm test
How to preform drop arm test
What is the correct shoulder position?
Arm is passively placed in 90 degrees of ABD w/ elbow straight and shoulder ER
Pt must hold arm in that position
unable = large/massive RTC tear
how do you preform the apprehension test?
What is considered a positive test
Place pt with arm in 90 of abduction and max ER
examiner applies Overpressure in ER while stabilizing the elbow
(+) will have apprehension indicating anterior GH instability
what is NOT considered a positive apprehension test
if the pt only has pain in the test position
The sulcus sign implies what kind of instability
multidirection or inferior instability of the GH
how do you test for the sulcus sign?
20-50 degrees of abduction and then apply downward traction
depression greater than 1 finger is positive b/t humeral head and acromion
How do you test a patient for posterior GH joint instability
posterior apprehension
flex arm to 90 then horizontally adduct and apply posterior force
positive if apprehension
How to preform an obrien test?
What is it for?
extend arm to shoulder height and fully IR, apply force
then do same with ER
positive test if more pain with IR than ER
SLAP lesion
how to preform a biceps load test?
What is it for?
Bring arm to 90 elevation, ER, and elbow flexion. for Biceps load test 1 and resist at forearm. Positive if shoulder pain
Bring arm to 120 for Biceps load test 2 (preferred test) positive if shoulder pain
SLAP lesion
If other instability tests are negative, what test can find old labral tears?
Clunk test
What is considered a positive scapular assistance test?
if decreased shoulder symptoms happen when you assist upward rotation of scap
how to preform the wall/floor pushup test?
Pt preforms 3-5 pushups and note any scapular weakness
What is a considered a positive pec minor tightness test
Difference in shoulder height/acromion from table
What 2 tests also work for AC joint pain?
What are the tests unique to AC joint?
Obrien’s (for SLAP) and Cross body abduction (for impingement)
positive if pain at AC joint
Palpation of AC joint, positive if pain
look for step deformity, if present it indicates separation
