shoulder orthos Flashcards
what are the best screens for shoulder pain?
- Apley’s scratch (ext rot C7; IR T7 use middle of hand)
- Wall angels (upper crossed syn)
Name the 5 tests to use for subacromial pain syndrome.
- Hawkins Kennedy (most sensitive)
- Painful Arc (most specific)
- Neers
- RSERT
- Empty can
How do you do the Hawkins Kennedy test?
Flex arm 90 then passively internally rotate shoulder.
+ve = pain : supraspinatus tendon pushes agst coracoacromial lig & coracoid process. Indicates supraspinatus tendinosis.
How do you do the painful arc?
abduction of the arm in the plane of the scapula.
+ve pain btn 60 - 120 (GH issue)
AC 160 - 180
How do you do the Neers test?
Passively and forcibly elevate arm in scapular plane with arm in IR/ER by examiner.
How do you do the RSERT?
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
how do you perform the empty can test?
Arm abd 90. IR. stabilize at wrist. Apply downward pressure while patient resists.
+ve weakness or pain for supraspinatus tendonitis/tear
what are important factors when thinking about shoulders
female
not employed
high level of physical load - lifting, carrying, pushing/pulling
46 - 55yrs
episode of arm, neck, shoulder complaints in last 12 months.
Factors associated with negative prognosis for shoulders.
- pain > 3 mo
- high intensity of pian at presentation
- high rating of disability at presentation
- restricted ROM
- more complex presentation
- psychosocial factors
what muscles generate torque through the shoulders?
lat dorsi
deltoid
serratus anterior
pec major
what sports are associated with repetitive shoulder movements and are more likely to present?
swimming
volley ball
baseball
what muscles are associated with maintaining scapular motion?
traps (UT, LT, MT)
rhomboids
levator scap
pec minor
what are the co-morbidities for rotator cuff tears?
tennis elbow
carpal tunnel syndrome
trigger fingers
achillies tendonitis
oral steroids
diabetes milletus
what are the four tests for rotator cuff pathology?
empty can (supraspinatus)
full can (infraspinatus)
bear hug / belly press (subscapularis)
resisted ER in scapular plane (infraspinatus & teres minor)
how do you perform the supraspinatus test?
(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
how do you perform the full can test?
thumbs pointing up
+ve weakness or pain in supraspinatus tendonitis /tear
how do you perform the belly press test?
what does it measure?
patient attempts to press hand agst abdomen (while moving elbow forward- chicken winging it) with resistence by examiner
subscapularis
how do you perform the bear hug test?
what does it measure?
place hand against alternative shoulder with hand open. Examiner pulls hand away. If weak or gives way = subscapularis weakness / tear
how do you perform the lift off test?
what does it measure?
place open hand in small of back.
lift away from back.
lift away from back with resistence from examiner
tests subscapularis
how do you perform resisted ER in scapular plane?
What does it measure?
standing sitting arm at side
elbow flexed 90 (thumb up)
apply IR force, patient resists.
+ve pain or inability to resist = infraspinatus strain
what are the tests to determine labral tears?
Compression rotation (grind test)
Obrien’s
Biceps load and shift I & II
Speeds
what are the most sensitive tests for labral tears?
- Compression rotation (aka grind test)
- anterior apprehension test
what is the most specific test for labral tears?
Biceps load and shift 1 & II
how do you perform the compression rotation test?
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
how do you perform the obrien test?
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.
how do you perform biceps load and shift I & II
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 .
How do you perform the speeds test?
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.
what are the tests for shoulder instability?
- sulcus sign
- Jerk Test
- Load and shift
- apprehension test + relocation + surprize
- scapular repositioning
- scapular assistance
- tight pecs
- punch test (serrratus anterior weakness)
how do you perform the Jobe/Apprehension test
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
how do you perform load and shift test?
what does it test for?
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
how do you perform the jerk test?
what does it measure?
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
what is the sulcus sign?
what does it measure?
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
