Shoulder Lab Flashcards
Possible hypotheses for description:
Lateral/anterior shoulder pain with overhead activities or exhibits a painful arc
subacromial impingement
tendinitis
bursitis
Possible hypotheses for description:
Instability, apprehension, and pain with activities, most often when shoulder is abducted and externally rotated
shoulder instability
possible labral tear if clicking is present
Possible hypotheses for description:
decreased ROM and pain with resistance
rotator cuff or long head of biceps tendinitis
Possible hypotheses for description:
Pain and weakness with muscle loading, night pain; Age > 60
Rotator cuff tear
Possible hypotheses for description:
Poorly located shoulder pain with occasional radiation into elbow; Pain is usually aggravated by movement and relieved by rest; Age > 45; Females > Males
Adhesive Capsulitis
Possibly hypotheses for description:
Fall on shoulder followed by pain over AC joint
AC sprain
Possibly hypotheses for description:
Upper extremity heaviness or numbness with prolonged postures and when lying on involved side
Thoracic outlet syndrome
Cervical radiculopathy
Palpation
- Compare both sides (especially if using palpation for a test); start superficially and then proceed to palpate more deeply
- Skin: temperature, mobility, perspiration, etc.
- Soft Tissue: muscle tone/atrophy, tenderness, nodules, etc.
Glenohumeral Joint close packed position
full abduction, full ER
glenohumeral joint open packed position
55 deg abd, 30 deg horiz abd, neutral rotation
glenohumeral joint capsular pattern
ER > abduction > IR > flexion
AC joint close packed position
90 deg glenohumeral abduction
AC joint open packed position
arm by the side
AC joint capsular pattern
pain at extremes of ROM, esp horizontal adduction and full elevation
SC joint close packed position
maximum arm elevation and protraction
SC joint open packed position
arm by the side
SC joint capsular pattern
pain at extremes of ROM, esp full arm elevation and horizontal adduction
Apley’s Scratch Test
- quick active mobility assessment tool
- ER & ABd (with flexion): overhead and reach for opposite shoulder
- IR and Add (with flexion): stresses infraspinatus and compresses AC joint - reach in front of the body for the opposite shoulder
- IR and Add (with extension): reach behind back for the scapulae
patient positioning for glenohumeral resisted motion testing
patient supine
55 deg abduction, 30 deg horiz add, neutral rotation
scapula resting position
arm at the side
elbow resting position
70 deg flexion, 10 deg supination
resisted motion coracobrachialis
flexion and adduction
resisted motion deltoid
abduction (primarily), and flexion/extension
resisted motion testing supraspinatus
abduction and lateral rotation (supraspinatus would be unaffected by horizontal motions - flexion and extension - like the deltoid)
resisted motion testing pec major
adduction, flexion, internal rotation
resisted motion testing latissimus dorsi
adduction, extension, internal rotation, scapular depression
resisted motion testing teres minor
adduction and lateral rotation
resisted motion testing teres major
adduction and medial rotation
resisted motion testing infraspinatus
lateral rotation (no pain on adduction or abduction)
resisted motion testing subscapularis
medial rotation (no pain on adduction)
palpation for sternocleidomastoid
significant for hematomas, lymph node enlargement (suggesting infection), trauma (e.g. “whiplash”), hypertrophy (assoc with actions such as rib cage elevation, utilized with COPD)
palpation for biceps brachii
can become inflamed or torn
palpation for deltoid
important due to its relationship with bursitis and axillary nerve damage
palpation for supraspinatus tendon
position patient sitting; max shoulder adduction, max medial rotation and max hyperextension. tendon is palpable just under acromion to a point anterior to AC joint
palpation for infraspinatus and teres minor tendons
position patient sitting; shoulder flexed to 90 deg, 10 deg adduction, and 20 deg lateral rotation. tendons are palpable deep to posterior deltoid, and inferior to acromion angle
second option for positioning to palpate infraspinatus tendon
positioning patient prone on elbows with the arms adducted and in lateral rotation. have patient weight shift onto test side and feel the tendon pop up under the scapular spine on weight shifting
palpation for subscapularis tendon
position patient sitting; shoulder adducted to thorax, neutral flexion/extension, and neutral medial/lateral rotation. insertion of tendon is palpable lateral to coracoid process at its insertion into the lesser tuberosity
palpation for long head of biceps brachii muscle
position patient sitting; 0 deg adduction, 20 deg medial rotation (“hand-on-lap” position)
- tendonitis might be differentiated from rotator cuff pathology by palpating the bicipital groove, which is more tender with tendonitis
- can also have patient resist flexion
palpation for subacromial and subdeltoid bursa
extend arm; palpate in the area of the anterior deltoid. look for thickenings, masses, tenderness, and crepitation
palpation of axilla (examine as a quadrilateral pyramid) list structures that border axilla
medial wall: ribs 2-6, serratus anterior, and lymph nodes
lateral wall: brachial artery is between coracobrachialis and long head of triceps
anterior wall: pec major
posterior wall: latissimus dorsi
muscle length testing of latissimus dorsi
o Patient Position: Supine with the hips/knees bent
o Method: Have patient flex upper extremities overhead while keeping the back neutral and elbows pointing towards ceiling. Monitor the lumbar spine and watch the rib cage – you should not note excessive movement in either location. Return to start position. Ensure lumbar spine is neutral, then passively support the humerus at the elbow and keeping the shoulder ER as you bring the arm into shoulder flexion- feel if stiff or short.
o Positive Response: Short - unable to reach full range of motion of shoulder flexion; Stiff – difficult to reach full range of motion of shoulder flexion
muscle length testing for scapulahumeral muscles (teres major, teres minor, infraspinatus)
o Patient Position: Supine with the hips/knees bent
o Method: You must test the latissimus length prior to this test. Stabilize scapula but allow inferior angle move to mid-axillary line. Passively support the humerus at the elbow and keep the shoulder ER as you bring the arm into shoulder flexion.
o Positive Response: Short – unable to reach same range as you achieved with latissimus length test; Stiff – difficult to achieve same range as latissimus length
muscle length testing for pec major (upper and lower divisions)
o Patient Position: Supine with knees flexed, back flat
o Method: Passively move the arm into the following positions. Lower (sternal) fibers: shoulders abducted to about 135º and full lateral rotation within sagittal plane of body. Upper (clavicular) fibers: shoulders abducted to 90º and full lateral rotation within sagittal plane of body.
o Positive Response: Short – unable to reach position; Stiff - difficult to achieve position
muscle length testing for pec minor
o Patient Position: Supine with the arms at the side, elbows and shoulders at same level.
o Method: Standing at the head of the table, the clinician measures the distance between the posterior acromion and the table for each shoulder. If the posterior acromion is greater than 1 inch, therapist faces patient, places hands on coracoid process and anterior acromion and tries to move acromion toward table.
o Positive Response: Short – unable to reach position where posterior acromion is less than 1 inch from the table; Stiff – difficult but able to achieve position where posterior acromion is less than 1 inch from the table
resisted motion testing for lateral rotators (infraspinatus, teres minor, and posterior deltoid)
o Patient Position: Supine with the arms abducted to 90 degrees.
o Method: With shoulder stabilized, move shoulder into medial rotation.
o Positive Response: Short – unable to reach 70 degrees; Stiff – difficult but able to achieve 70 degrees
resisted motion testing for medial rotators (subscapularis, lattisimus dorsi, and pec major)
o Patient Position: Supine with the arms abducted to 90 degrees.
o Method: With shoulder stabilized, move shoulder into lateral rotation.
o Positive Response: Short – unable to reach 90 degrees; Stiff – difficult but able to achieve 90 degrees
Apprehension test
-testing capsule(as tool for identifying shoulder instability, Sensitivity .40-.53, Specificity .87-.99)
Patient Position: supine
Clinician Position: beside the patient
Method: Abduct the patient’s shoulder to 90º, with elbow bent 90º, and SLOWLY attempt to fully laterally rotate
Positive Response: pain or apprehension with lateral rotation
Relocation test
- testing capsule (identifying shoulder instability, sensitivity .57-.68, specificity 1.0)
- assessment: confirm anterior instability after complete apprehension test
- patient position: supine
- clinician position: beside patient
- method: add a posterior force at GH joint when arm is abducted to 90, with elbow bent at 90, & fully laterally rotated. following relocation test, examiner applies anteriorly directed force to proximal humerus
- positive response: apprehension is reduced when posterior force is applied; apprehension is created with anterior force
load and shift test
- tool for anterior shoulder instability
- Patient Position: seated without back support but with proper posture, hands resting on his/her thigh
- Clinician Position: behind the patient
- Method: The therapist stabilizes the scapula/clavicle with the near hand. With the far hand, the therapist grasps the head of the humerus (thumb on the posterior aspect and fingers over the anterior aspect: long finger over the coracoid process). The head of the humerus is “seated” in the glenoid, usually posteriorly (load) and then moved in an anteromedial direction to test for anterior instability and posterolateral direction to test for posterior instability (shift). The humerus should not ride up and/or over the glenoid rim.
- Positive Response: comparison to the uninvolved side regarding symptoms (vs. movement) is considered significant
Sulcus sign
- testing capsule (as a tool for shoulder instability)
- Assessment: multidirectional instability, especially inferior shoulder instability
- Patient Position: sitting
- Clinician Position: beside the patient
- Method: the therapist grasps at or above the patient’s elbow and pulls the arm downward
- Positive Response: a sulcus (or rim) above the humerus
Labral Crank Test
- testing labrum and articulating surfaces (as tool for detecting labral tear, Sensitivity .46-.91, Specificity .56-.93)
- Patient Position: supine
- Clinician Position: beside patient
- Method: the examiner elevates the humerus to 160º in the scapular plane. Axial load is applied to the humerus while the shoulder is medially and laterally rotated.
- Positive Response: pain is elicited
Clunk Test
- testing labrum and articulating surfaces (as tool for detecting labral tear, SLAP lesion, Sensitivity .15)
- Patient Position: supine
- Clinician Position: one hand of the clinician is placed on the posterior aspect of the shoulder over the humeral head, the other hand grasps the humerus above the elbow
- Method: the clinician passively abducts the arm over the patient’s head; the clinician uses the hand on the humeral head to push anteriorly while the other hand applies a compressive force along the humeral shaft into the glenoid cavity while laterally rotated the humerus
- Positive Response: click, clunk-like sensation felt, or pseudo-locking occurs
(O’Brien’s) Active Compression Test
- testing labrum and articulating surfaces (as tool for detecting SLAP lesion, Sensitivity .47-.94, Specificity .11-.55)
- Patient Position: standing
- Clinician Position: next to patient
- Method: The patient’s involved arm is placed in 90º flexion and 10º adduction, and fully internally rotated. The elbow is in full extension. The therapist provides a downward force on the arm (usually at the wrist and elbow). This maneuver is repeated with the arm in full external rotation.
- Positive Response: positive for a SLAP lesion if deep joint pain is reported with resistance in the IR position, but lessens or disappears in the ER position. If superficial joint pain occurs, consider AC joint pathology
Yergason’s Test
- testing labrum and articulating surfaces (as tool for identifying labral tears, Sensitivity .13, Specificity .87-1.0; as tool for identifying bicipital tendonitis)
- Patient Position: standing or sitting
- Clinician Position: beside patient, place one hand over long head of biceps tendon, grasp patient’s hand with other hand
- Method: Start with the patient’ elbow bent to 90⁰ and forearm pronated; resist as the patient attempts to supinate and laterally rotate the arm.
- Positive Response: pain at biceps tendon
Quadrant Test
- testing labrum and articulating surfaces (as tool for assessing articulating surfaces of the GH joint, Sensitivity/ Specificity not listed)
- Patient Position: supine
- Clinician Position: beside patient
- Method: Place one hand on scapula so fingers on upper trapezius. Externally rotate the shoulder and grasp the elbow (flexed to 90) with the other hand, keeping the elbow flexed. Start with elbow positioned 10 degrees posterior to the frontal plane. Abduct the shoulder, feeling through an arc of motion within the GH joint- end range is achieved in maximal abduction and external rotation.
- Positive Response: pain, crepitus and/or limitation of range of motion
