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lower limb orthopedics > shoulder orthos > Flashcards

shoulder orthos Flashcards

1
Q

what are the best screens for shoulder pain?

A
  1. Apley’s scratch (ext rot C7; IR T7 use middle of hand)
  2. Wall angels (upper crossed syn)
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2
Q

Name the 5 tests to use for subacromial pain syndrome.

A
  1. Hawkins Kennedy (most sensitive)
  2. Painful Arc (most specific)
  3. Neers
  4. RSERT
  5. Empty can
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3
Q

How do you do the Hawkins Kennedy test?

A

Flex arm 90 then passively internally rotate shoulder.
+ve = pain : supraspinatus tendon pushes agst coracoacromial lig & coracoid process. Indicates supraspinatus tendinosis.

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4
Q

How do you do the painful arc?

A

abduction of the arm in the plane of the scapula.
+ve pain btn 60 - 120 (GH issue)
AC 160 - 180

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5
Q

How do you do the Neers test?

A

Passively and forcibly elevate arm in scapular plane with arm in IR/ER by examiner.

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6
Q

How do you do the RSERT?

A

Seated, shoulder abd 90, elbow flexed 90. Support wrist and elbow. Passively ER shoulder to end range using wrist. Ask patient to maintain when wrist is released.
+ve unable to hold, spings back

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7
Q

how do you perform the empty can test?

A

Arm abd 90. IR. stabilize at wrist. Apply downward pressure while patient resists.
+ve weakness or pain for supraspinatus tendonitis/tear

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8
Q

what are important factors when thinking about shoulders

A

female
not employed
high level of physical load - lifting, carrying, pushing/pulling
46 - 55yrs
episode of arm, neck, shoulder complaints in last 12 months.

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9
Q

Factors associated with negative prognosis for shoulders.

A
  1. pain > 3 mo
  2. high intensity of pian at presentation
  3. high rating of disability at presentation
  4. restricted ROM
  5. more complex presentation
  6. psychosocial factors
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10
Q

what muscles generate torque through the shoulders?

A

lat dorsi
deltoid
serratus anterior
pec major

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11
Q

what sports are associated with repetitive shoulder movements and are more likely to present?

A

swimming
volley ball
baseball

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12
Q

what muscles are associated with maintaining scapular motion?

A

traps (UT, LT, MT)
rhomboids
levator scap
pec minor

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13
Q

what are the co-morbidities for rotator cuff tears?

A

tennis elbow
carpal tunnel syndrome
trigger fingers
achillies tendonitis
oral steroids
diabetes milletus

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14
Q

what are the four tests for rotator cuff pathology?

A

empty can (supraspinatus)
full can (infraspinatus)
bear hug / belly press (subscapularis)
resisted ER in scapular plane (infraspinatus & teres minor)

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15
Q

how do you perform the supraspinatus test?

A

(empty can)
straight arms abducted 90 & IR (thumb down)
stabilise patients arms at wrist
put downward pressure while patient resists
+ve weakness or pain for supraspinatus tendonitis or tear

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16
Q

how do you perform the full can test?

A

thumbs pointing up
+ve weakness or pain in supraspinatus tendonitis /tear

17
Q

how do you perform the belly press test?
what does it measure?

A

patient attempts to press hand agst abdomen (while moving elbow forward- chicken winging it) with resistence by examiner
subscapularis

18
Q

how do you perform the bear hug test?
what does it measure?

A

place hand against alternative shoulder with hand open. Examiner pulls hand away. If weak or gives way = subscapularis weakness / tear

19
Q

how do you perform the lift off test?
what does it measure?

A

place open hand in small of back.
lift away from back.
lift away from back with resistence from examiner
tests subscapularis

20
Q

how do you perform resisted ER in scapular plane?
What does it measure?

A

standing sitting arm at side
elbow flexed 90 (thumb up)
apply IR force, patient resists.
+ve pain or inability to resist = infraspinatus strain

21
Q

what are the tests to determine labral tears?

A

Compression rotation (grind test)
Obrien’s
Biceps load and shift I & II
Speeds

22
Q

what are the most sensitive tests for labral tears?

A
  1. Compression rotation (aka grind test)
  2. anterior apprehension test
23
Q

what is the most specific test for labral tears?

A

Biceps load and shift 1 & II

24
Q

how do you perform the compression rotation test?

A

Patient supine
ABd shoulder 20 - 90 with elbow flexed 90.
apply axial compression through humerus while passively rotating humerus back and forth trying to trap labrum.
+ve: pain, clicking or catching sensation

25
Q

how do you perform the obrien test?

A

flex arm fwd 90, elbow fully extended.
horizontally abd 10 - 15.
IR (thumb down)
apply downward force resisted by client.(painful)
rotate palm up apply force. If not painful
= labral tear sign.

26
Q

how do you perform biceps load and shift I & II

A

Shoulder abd 90 & ER.
elbow flexed 90; forearm supinated
Take arm into full ER.
if apprehension stop & hold: ask patient to flex agst resistence at wrist. if more comfortable = -ve for labral tear
If as/more painful = +ve labral tear

II: performed with 120 deg of abduction .

27
Q

How do you perform the speeds test?

A

patient arm by side,
supinated
contact bicipital groove and hold wrist
Resist fwd flexion in supination then pronation with elbow extended.
+ve inc tenderness in bicipital groove esp when supinated = bicipital tendonitis
profound weakness on resisted supination = severe rupture or strain distal biceps.

28
Q

what are the tests for shoulder instability?

A
  1. sulcus sign
  2. Jerk Test
  3. Load and shift
  4. apprehension test + relocation + surprize
  5. scapular repositioning
  6. scapular assistance
  7. tight pecs
  8. punch test (serrratus anterior weakness)
29
Q

how do you perform the Jobe/Apprehension test

A

patient supine, shoulder abducted to 90.
stabilize elbow and wrist externally rotate patients shoulder
stop at point of apprehension or pain
+ve: pain or fear of dislocation
apply anterior pressure over humeral head /anterior shoulder
+ve: relocation dec pain

30
Q

how do you perform load and shift test?
what does it test for?

A

seated with good posture.
Stabilize clavicle and spine of scapular with one hand
Other hand grab humeral head
Translate anterior and posterior.
+ve if pain reproduced or one side translates sig more than other.
tests shoulder instability

31
Q

how do you perform the jerk test?
what does it measure?

A

sitting with arm IR & fwd flexed 90.
grasp elbow and axially load humerus in proximal direction.
stabilize scap with other hand
more arm horizontally into adduction
+ve: sudden jerk or clunk. Arm
returning horizontally into abduction may create 2nd jerk
measure of shoulder instability

32
Q

what is the sulcus sign?
what does it measure?

A

stand with shoulder muscles relaxed
grasp arm below elbow and pull down
visible line below acromion indicates inferior or multidirectional instability
feeling of subluxation might be present.
measure: shoulder instability

lower limb orthopedics (5 decks)

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