Shoulder practical manual Flashcards
How do you palpate the inferior angle of the scapula?
Model → Sitting edge of plinth with feet supported on a stool - arm medially rotated behind back.
Technique →Identify the prominence of the angle by palpating the tip and the lower medial and lateral borders of the scapula.
How do you palpate the spine of the scapula?
Model → Edge of plinth w/feet on stool - arm held by side
Technique → Identify the crest of the spine of the scapula and palpate along the spine towards medial border (starting point). Now palpate along full extent of spine moving laterally to finish your palpation at the angle where the acromion process commences.
How do you palpate the acromion process?
Model → Edge of plinth w/feet on stool - arm by side
Techniqiue → Identify angle btween lateral end of spin and acromion process (starting point) - now palpate along the lateral border of the acromion to finish your palpation at the anterior tip. - then palpate superior surface.
How do you palpate the clavicle?
Model → same
Technique → Jugular notch and identify bony prominence lateral to it - medial end of clav. Now palpate along the length of the clavicle moving from anterior to the superior aspect as you move your fingers laterally. Finish palpation at point where clavicle dips down (AC joint).
How do you palpate the coracoid process?
Model → same
Technique → Cup hand over the superior aspect of the model’s shoulder. Using the pad of your 4th digit, palpate under the the lateral one-third of the clavicle for a bony point which may cause slight discomfort to the model (this is the cp).
How do you palpate the greater tubercle of humerus?
Model → same
Technique → Identify lateral border of acromion process. Palpate below this body prominence to identify a further bony point.
How do you palpate the lesser tubercle of humerus?
Model → same
Technique → Cup hand over superior aspect of model’s shoulder. Use the pad of your 4th digit to identify the coracoid process. The Pad of 2nd digit should rest over the lesser tubercle.
→→To help confirm this, passively medially rotate the model’s arm and the bony point should move under your finger tip.
What is important to consider regarding palpation?
Explain to the model what you are planning to do and make them aware of the process for adequately and appropriately undressing → informed consent before proceeding.
What is the classification of the acromioclavicular joint?
Synovial, complex, plane, multi-axial
How to palpate the AC joint?
Palpate along length of clavicle moving from anterior to superior aspect as fingers move laterally.
The joint line is indicated at the point where the clavicle dips down.
To confirm the accuracy of this, ask model to shrug shoulder gently to help identify movement occuring at the joint.
What is the classification of the sternoclavicular joint?
Synovial, complex, saddle - functionally a ball and socket, multi axial
How to palpate the SC joint?
Commence palpation at jugular notch and identify medial end of clav. with one finger.
To confirm the accuracy of this, ask model to shrug shoulder gently to help identify movement opccurring at the joint.
What is the classification of the glenohumeral joint?
Synovial, simple, ball and socket, multi-axial
How to palpate the GH joint?
𝗔𝗻𝘁𝗲𝗿𝗶𝗼𝗿 𝘀𝘂𝗿𝗳𝗮𝗰𝗲 𝗺𝗮𝗿𝗸𝗶𝗻𝗴
Cup hand over sup. aspect of model’s shoulder. Identify coracoid process and lesser tubercle of humerus as normal. Where the middle finger rests will be the position of the shoulder joint line . (concave laterally).
𝗣𝗼𝘀𝘁𝗲𝗿𝗶𝗼𝗿 𝘀𝘂𝗿𝗳𝗮𝗰𝗲 𝗺𝗮𝗿𝗸𝗶𝗻𝗴
Identify the angle merking the junction between the lateral end of the spine and beginning of acromion process. Move 2cm inferiorly and 2cm medially and indicate the size and direction of the joint line.
Limiting factors to elevation?
Sternoclavicular joint: Tension in costoclavicular ligs. and subclavius muscle
Acromioclavicular joint: Coracoclavicular lig (both bands)
Limiting factors to depression?
Sternoclavicular joint: Interclavicular lig. and intra-articular disc
Limiting factors to protraction?
Sternoclavicular joint: Sternoclavicular lig. and costoclavicular ligament
Acromioclavicular joint: Coracoclavicular ligament and fibrous capsule
Limiting factors to retraction?
Sternoclavicular joint: Sternoclavicular ligament and costoclavicular ligament
Acromioclavicular joint: Coracoclavicular ligament and fibrous capsule
How is the model positioned at the start of flexion, extension and abduction goniometry ?
Sitting on stool - arm held by the side
Can stand up if smaller/same height as the model
What is normal ROM for shoulder flexion?
0-180 degrees
What is normal ROM for shoulder extension?
0-70 degrees
What is normal ROM for abduction?
0-170 degrees
Command to patient for shoulder flexion?
Keep your elbow straight and lead with your thumb. move your arm as far upwards in front of you as you can.
Command for shoulder extension?
Keep your elbow straight and lead with your little finger. Move your arm as far backwards behind you as you can.
Command for shoulder abduction?
Keep your elbow straight and lead with your thumb.
Move your arm as upwards towards your ear as you can.
Look for unwanted Cx spine lateral flexion
Limiting factors to shoulder flexion?
- Tension in capsular structures
- Surrounding opposing musculature : shoulder extensors
Limiting factors to shoulder extension?
- Tension in capsular structures
- Opposing musculature - flexors
Limiting factors to shoulder abduction?
Glenohumeral ligs. (middle and inferior bands) and inferior part of the fibrous capsule
Limiting factors to shoulder medial rotation?
- Extent of articular surfaces
- Tension in lateral rotators
Limiting factors to shoulder lateral rotation?
- Extent of articular surfaces
- Anterior capsule
- GHJ ligaments (all)
- Tension in medial rotators
What is SAPS?
Subacromial pain syndrome → a type of non-traumatic shoulder pathology characterised by pain generated by structures within the subacromial space.
→ If all 3 tests are positive, there is a high likelihood of SAPS.
→ 2 positive tests returns a moderate likelihood of SAPS
What are 3 SAPS tests?
Hawkins kennedy test
Infraspinatus muscle test
Painful arc - in scapular plane
Positive for hawkins kennedy test?
Test is positive if the model experiences their familiar pain
(should be left until the end of the assessment so it is not repeated more than once)
Positive for infraspinatus muscle test?
(pushing arms in)
Test is positive if the model experiences familiar pain and/or weakness
Positive for painful arc test?
Instruct to report pain as soon as it is felt.
The test is considered positive if the model experiences an onset of pain between ~40 and ~120 degrees of shoulder abduction which eases <~40 degrees and >~120 degrees of abduction.
What is a rotator cuff tear?
→ Rotator Cuff tears are muscle injuries sustained to one or more members of the rotator cuff unit.
→ Can be partial or full thickness and occur at various locations within the muscle.
→ Can be traumatic or non-traumatic
→ Caused by an accumulation od degeneration and frequent injury/trauma
What are the 3 tests for rotator cuff tears?
Painful arc
Infraspinatus muscle test
Drop arm test
What is the drop arm test and what is a positive result?
1.Instruct to report any pain during test as soon as it is felt.
2. Instruct model to abduct arm in scapular plane of movement to 90 degrees.
3. Model then instructed to slowly lower the arm back to the side.
The test is considered positive if the model experiences either pain or weakness on the returning the arm to the side which causes the arm to ‘drop’ suddenly.
If the rotator cuff tears are positive, further rotator cuff tests can be undertaken for specific muscles.
What are these muscle tests?
Infraspinatus muscle test → infraspinatus
Drop arm test → supraspinatus
Bear hug test → subscapularis
Hornblower’s sign (Patte test) → teres minor
How to carry out bear hug test and positive result?
- The model is instructed to report any pain experienced during the test as soon as it’s felt.
- Palm of hand on patient’s affected side is placed on opposite hsoulder with fingers extended and elbow positioned ant. to body.
- Patient is asked to hold that position as the examiner tries to pull the patient’s hand from the shoulder with an external rotation force applied perpendicular to the forearm.
The test is positive if the patient is unable to resst the examiners external rotation power - either due to pain or weakness - and if affected arm exhibits weakness compared w/contralateral side.
How to carry out hornblower test and positive result?
- Instruct model to report any pain experienced during test as soon as it is felt
- The model’s shoulder is flexed to 90 degrees with the elbow flexed to 90 degrees
- Model instructed to maintain this position
The test is considered positive if the patient is unable to maintain this position - either through pain or weakness.
What is the test for ACJ dysfyunction?
Scarf test
- Report any pain as soon as it is felt
- Ask to reach horizontally across their body towards their opposite shoulder.
- Apply pressure on arm (pushing it further back)
Positive test if pain reproduced in region of the ACJ → this test compresses the joint surfaces of the ACJ together and may indicate ACJ dysfunction.
What are the accessory movements of the shoulder region?
𝐒𝐭𝐞𝐫𝐧𝐨𝐜𝐥𝐚𝐯𝐢𝐜𝐮𝐥𝐚𝐫 𝐣𝐨𝐢𝐧𝐭
→Medial end of clavicle
→ Supine lying, pillow under humerus
→ Thumbs adjacent to SCJ , fan out fingers for stability, AP glide
𝐀𝐜𝐫𝐨𝐦𝐢𝐨𝐜𝐥𝐚𝐯𝐢𝐜𝐮𝐥𝐚𝐫 𝐉𝐨𝐢𝐧𝐭
→ Lateral end of clavicle
→ Supine lying, pillow under the humerus
→ Locate lat. end of clav, thumb tip technique in AP
On females don’t splay the fingers!!
𝐆𝐥𝐞𝐧𝐨𝐡𝐮𝐦𝐞𝐫𝐚𝐥 𝐉𝐨𝐢𝐧𝐭
→ Movement of head of humerus in AP
→ Supine with pillow under humerus, hand on stomach
→ Stabalise scapula, glide head in AP with “heel” of other hand
𝐋𝐨𝐧𝐠𝐢𝐭𝐮𝐝𝐢𝐧𝐚𝐥 𝐂𝐚𝐮𝐝𝐚𝐝 𝐦𝐨𝐯𝐞𝐦𝐞𝐧𝐭 (𝐇𝐮𝐦𝐞𝐫𝐮𝐬)
→Pillow under humerus, bed high
→ Stand at the side, with patient’s elbow in 90 degrees flexion, hold patient’s wrist with one hand and grasp.
→ Grasp around anterior surface of the patient’s upper arm with your other hand
→ Direct pressure in longitudinal caudad direction
What AP movement mimicks shoulder flexion and why?
AP Humerus
The head of humerus is a convex surface articulating with the concave glenoid fossa.
What accessory movement mimicks shoulder abduction?
Longitudinal caudad of humerus
