Shoulder Pain Flashcards
Steps of shoulder pain competency
Verbalize and perform inspection of affected joint
Palpate affected joint
Range of motion bilaterally for 4 motions
Muscle strength
Biceps and triceps deep tendon reflexes
Radial pulse
Sensation of upper extremity
Osteopathic structural exam: verbalize all four components of TART
Specialty test: verbalize definition of a positive test
Verbalize indicated pathology
ALWAYS DO BILATERALLY
Valgus deformity
Distal part of limb directed away from midline (“knock knees”
Varus deformity
Distal part of limb directed toward midline (“bowlegs”)
Deep tendon reflexes
Bicipeps
Brachioradialis
Triceps
+3/5 active movement against gravity
Vascular examination
Capillary refill
Compress digit between index and thumb to cause blanching, release pressure and note time to regain color
Radial pulse
Proximal to thumb
+2/4 average intensity, expected, normal
Examination of Edema
Dorsum of foot Anterior tibia Behind medial malleolus 0=absent 1+=barely detectable, disappears rapidly 2+=slight indentation 3+=deeper indentation 4+=very marked indentation
Osteopathic structural exam
Must document the named lesion/dysfunction or describe at least 2 of the 4 TART findings
Apprehension test
Shoulder abducted to 90 degrees and elbow flexed to 90 degrees
Stabilize shoulder with one hand (blocking linkage) and force arm into external rotation with the other hand
(+) test: pt apprehensive of repeat dislocation
Indicates: glenohumeral instability
Glenohumeral Instability
Apprehension Test
Sulcus Sign
Bicipital Tendon Pathology
Yergason’s test
Speed’s test
Sulcus Sign
Grasp pt’s elbow and apply inferior traction
(+) test: indention appears in area beneath the acromion
Indicates: glenohumeral instability
Rotator Cuff Pathology
Empty Can Test
Drop-arm test
Yergason’s Test
Pt arm at side with elbow flexed to 90 degrees
Physician uses one hand to palpate bicipital groove and monitors there, while the other hand grasps the pt’s wrist
Pt supinate and externally rotates against physician’s resistance
(+) test: pain and/pr tendon subluxation out of groove
Indicates: unstable bicipital
Speed’s test
Pt arm flexed (50-90 degrees) at the shoulder with hand supinate
Slightly flex pt’s elbow
Resist at forearm while pt flexes shoulder
(+) test: pain in bicipital groove
Indicates: bicipital tendonitis of long head biceps
Empty Can Test
Flex pt shoulders to 90 degrees while horizontally abducting to 45 degrees
Internally rotate both arms so thumbs are pointing down
Press down on forearms while pt resists
(+) test: pain or weakness
Indicates: rotator cuff pathology (specifically supraspinatus)
Drop Arm test
Pt abducts arm to 90 degrees, then slowly drops arm
(+) Test: arm willl drop or gentle tap on wrist will cause arm to drop
Indicates: full thickness tear of supraspinatus
Rotator cuff impingement
Painful arc test
Neer impingement
Hawkins test
Painful Arc Test
Pt abducts arm starting at their side
(+) test: pain is elicited within 60-120 degrees of shoulder abduction
Indication: Subacromail impingement and/or rotator cuff injury
Neer impingement
Stabilizes pt’s shoulder
With forearm pronated, passively flex shoulder to fully flexed position
(+) test: pain
Indication: subacromial bursa or rotator cuff impingement
Hawkins Test
Flex shoulder to 90 degrees, flex elbow to 90 degrees, and passively rotate the humerus into internal rotation
This opposes rotator cuff against coracoacromial L. And acromion
(+) Test: pain
Indicates: rotator cuff or subacromial bursa impingement
Lift off test
Subscapularis
Place pt’s arm into internal rotation and extension
Pt pushes arm into further internal rotation as physician resists
(+) test: weakness (inability to resist)
Indicates: subscapularis weakness
Cross Arm Test
Acromioclavicular Joint
Physician passively adducts pt’s arm across their chest and rests pt’s hand on their opposite shoulder
(+) Test: pain in AC joint with end range adduction
Indicates: AC joint pathology
Range of Motion
Apley Scratch Test
Physician should make note of how far the pt can reach
Upper: pt abducts arm placing palm of hand behind their neck with palm facing toward the body. Pt should attempt to scratch the lowest possible vertebrae (coupled external rotation and abduction)
Lower: pt places arm behind their back with palm facing outward and dorsum of hand resting on their mid back. Pt should attempt to scratch the highest possible vertebrae (coupled internal rotation and adduction)
