Shoulder Pain

Question 1

Steps of shoulder pain competency

Answer 1

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

Question 2

Valgus deformity

Answer 2

Distal part of limb directed away from midline (“knock knees”

Question 3

Varus deformity

Answer 3

Distal part of limb directed toward midline (“bowlegs”)

Question 4

Deep tendon reflexes

Answer 4

Bicipeps
Brachioradialis
Triceps
+3/5 active movement against gravity

Question 5

Vascular examination

Answer 5

Capillary refill

Compress digit between index and thumb to cause blanching, release pressure and note time to regain color

Question 6

Radial pulse

Answer 6

Proximal to thumb

+2/4 average intensity, expected, normal

Question 7

Examination of Edema

Answer 7

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

Question 8

Osteopathic structural exam

Answer 8

Must document the named lesion/dysfunction or describe at least 2 of the 4 TART findings

Question 9

Apprehension test

Answer 9

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

Question 10

Glenohumeral Instability

Answer 10

Apprehension Test

Sulcus Sign

Question 11

Bicipital Tendon Pathology

Answer 11

Yergason’s test

Speed’s test

Question 12

Sulcus Sign

Answer 12

Grasp pt’s elbow and apply inferior traction
(+) test: indention appears in area beneath the acromion
Indicates: glenohumeral instability

Question 13

Rotator Cuff Pathology

Answer 13

Empty Can Test

Drop-arm test

Question 14

Yergason’s Test

Answer 14

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

Question 15

Speed’s test

Answer 15

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

Question 16

Empty Can Test

Answer 16

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)

Question 17

Drop Arm test

Answer 17

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

Question 18

Rotator cuff impingement

Answer 18

Painful arc test
Neer impingement
Hawkins test

Question 19

Painful Arc Test

Answer 19

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

Question 20

Neer impingement

Answer 20

Stabilizes pt’s shoulder
With forearm pronated, passively flex shoulder to fully flexed position
(+) test: pain
Indication: subacromial bursa or rotator cuff impingement

Question 21

Hawkins Test

Answer 21

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

Question 22

Lift off test

Answer 22

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

Question 23

Cross Arm Test

Answer 23

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

Question 24

Range of Motion

Answer 24

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)