The Shoulder Flashcards
A patient comes to you with a suspected supraspinatus tear. Which provocative assessment would you use to evaluate this patient?
A. Hawkin’s
B. Forced forward extension
C. Drop arm
D. Empty can
C. Drop arm *best answer of all 4
Explanation:
(A) Hawkin’s = impingement of subacromial space
(B) Forced forward extension = impingement
(D) Empty can = supraspinatus tendon and/or muscle involvement
Match the following provocative tests to the rotator cuff muscle they assess.
A. Subscapularis (hint: IR)
B. Infraspinatus (hint: ER)
C. Supraspinatus (hint: abducts)
___ External rotation at the side
___ Belly press test
___ Empty can test
Infraspinatus = External rotation at the side
Subscapularis = Belly press test
Supraspinatus = Empty can test
Which of the following is not a cause of scapulohumeral dysrhythmia?
A. Poor or abnormal posture
B. Pectoralis minor tightness
C. Joint pain
D. Periscapular muscle performance
C. Joint pain
Explanation:
(C) because joint pain may cause guarding, but won’t cause hiking or dumping.
Which 3 landmarks are used to assess a dropped scapula?
A. Acromion
B. Spine
C. Inferior angle
D. Superior border
E. Medial border
F. Lateral border
(A) Acromion; highest point
(C) Inferior angle; lowest point/farthest form vertebrae
(E) Medial border; closest to vertebrae
The scapular retraction test helps you assess:
A. Effect of scapular kinematics on supraspinatus strength
B. Effect of scapular kinematics on infraspinatus strength
C. Effect of scapular kinematics on subscapularis strength.
D. Effect of scapular kinematics on pectoralis minor strength.
A. Effect of scapular kinematics on supraspinatus strength (because arm in slight abduction - full can)
Explanation:
(B) Effects of scapular kinematics on infraspinatus strength & (C) subscapularis = not testing IR/ER strength on scapula
(D) Pectoralis minor is not a RTC muscle
OT management for the shoulder is similar to which other area of the UE?
A. Hand
B. Wrist
C. Elbow
B. Wrist
Explanation:
1. Rest
2. Activity modification
3. Avoid aggravation
Acute stage (rheumatic)
Tendinopathy
Wrist
Shoulder
For restoring mobility to the shoulder, order the activities below from easiest to hardest (all forward elevation).
A. Supine extension to flexion
B. Seated overhead row
C. Standing rocking a dowel forward/back
D. Passive flexion by therapist
- Passive flexion by therapist (passive; MMT = 2)
- Standing rocking a dowel forward and back (gravity eliminated active assisted; MMT = 2, 2+ maybe)
- Seated overhead row (gravity eliminated, active assistive; MMT = 2, 2+ maybe)
- Supine extension to flexion (active; MMT = 3)
Progressive resistive exercises are an essential aspect of OT management in shoulder rehabilitation.
A. True
B. False
B. False
Explanation:
Even if it says so on the Rx, not all patients need it. You need to have a clear rationale for using it.
Your patient complains of pain when reaching overhead to put away dishes latching her bra behind her back, donning and doffing shirt sleeves, and pain at night. What condition do you suspect?
A. Joint contracture
B. Frozen shoulder
C. Rotator cuff tendinopathy
D. Shoulder instability
C. Rotator cuff tendinopathy; pain at night, overhead, abduct, IR, crossing
Explanation:
(A) Joint contracture; The patient’s ROM isn’t limited
(B) Frozen shoulder; You’d see limitations in passive movements as well
(D) Shoulder instability; You’d see apprehension (fear of dislocation)
Which of the following provocative tests could be used to asses? [Your patient complains of pain when reaching overhead to put away dishes latching her bra behind her back, donning and doffing shirt sleeves, and pain at night. What condition do you suspect?]
A. Cozen’s
B. Empty can
C. Finkelstein’s
D. Hawkin’s
(D) Hawkin’s; also Neer’s and Speed.
Explanation:
(A) Cozen’s tests lateral epicondylitis/tennis elbow (extensors)
(B) Empty can tests supraspinatus muscle/tendon
(C) Finkelstein’s tests DeQuervaine’s
For which shoulder condition are apprehension tests used?
A. Frozen shoulder
B. Shoulder instability
C. Rotator cuff tear
D. Scapular dyskinesis
B. Shoulder instability; if you have a dislocated shoulder, you’d be apprehensive to have it pressed on.
Explanation:
(A) Frozen shoulder; very painful
(C) Rotator cuff tear; you’ll re-injure
(D) Scapular dyskinesis; none of these tests assess scapular movement.
Rhythmic stabilization exercises are not appropriate for shoulder instability.
A. True
B. False
B. False
You are seeing a patient post-op from a Bankart procedure (a surgical procedure that treats shoulder instability by reattaching and tightening torn ligaments and labrum). What is the most important aspect of management?
A. Protection
B. Mobility
C. Strength
D. Posture
A. Protection
Explanation:
Then posture, next mobility. Strength as needed, but with purpose.
In frozen shoulder…
A. No PROM/AROM
B. Some PROM/AROM
C. PROM > AROM
D. PROM = AROM
B. Some PROM/AROM; it’s limited, and very painful
Explanation
(A) No PROM/AROM; would be a severe contracture
(C) PROM > AROM; would indicate nerve issues
(D) PROM = AROM; this would be normal
You are seeing a patient with frozen shoulder. What is the most important aspect of OT management?
A. Protection
B. Mobility
C. Strength
D. posture
B. Mobility; we want to low load prolonged stretch (LLPS)
Explanation:
(A) Protection; this would encourage guarding.
(C) Strength; as needed, but with purpose.
(D) Posture; can be in education, but not the most important.
