The Shoulder

Question 1

What muscles flex the shoulder joint? (5)

Answer 1

Deltoid (anterior head)
Pectoralis major
Biceps brachii
Coracobrachialis
Serratus anterior

Question 2

What muscles extend the shoulder joint? (5)

Answer 2

Deltoid (posterior head)
Latissimus dorsi
Teres major
Triceps brachii (long head)
Pectoralis major

Question 3

What muscles abduct the shoulder point?

Answer 3

Deltoid

Supraspinatus

Question 4

What muscles adduct the shoulder point?

Answer 4

Latissimus dorsi
teres major
pectoralis major
coracobrachialis
triceps brachii (long head)

Question 5

Origin and insertion of teres major
innervation
Action (3)

Answer 5

origin : inferior angle of the scapula
insertion: intertubercular groove of humerus
lower subscapular nerve (C05, C06)
adduction, extension, and medial (internal) rotation of the humerus.

Question 6

What are the three tests of rotator cuff dysfunction (test cluster)

Answer 6

drop arm test
painful arc sign
weak external rotation of glenohumeral joint

Question 7

what is the primary external rotator of the rotator cuff muscles?

Answer 7

infraspinatus muscle

Question 8

what is external impingement?

Answer 8

the rotator cuff is impinged in the sub-acromial space.

Question 9

what is another name for external impingement?

Answer 9

subacromial impingement

Question 10

what is internal impingement?

Answer 10

pinching of the inferior surface of the rotator cuff tendons and the glenoid labrum between the head of the humerus (commonly the greater tuberosity) and the posterior-superior aspect of the glenoid.

Question 11

what is the Hawkins-Kennedy Test used for?

Answer 11

Testing external (sub-acromial) impingement

Question 12

what four tests are used for external impingement? (sub-acromial)?

Answer 12

Hawkins-Kennedy Test
Empty can/ Full Can
Painful arc and weak external rotation

Question 13

what two tests are used for internal impingement?

Answer 13

Internal rotation resisted strength test (IRRST)

Neers test

Question 14

what test can be used to distinguish internal versus external impingement?

Answer 14

Internal rotation resisted strength test (IRRST)

Question 15

what three tests can be used for subscapularis dysfunction?

Answer 15

bear hug test
lift off test
Napoleon or belly press test

Question 16

what two tests are used for Acromioclavicular joint dysfunction?

Answer 16

scarf test

paxinos test

Question 17

what is the test for long head of Biceps Brachii Tendinopathy?

Answer 17

Yergason’s test

Question 18

Explain the Yergason’s test

Answer 18

Patient actively flexes elbow to 90 degrees and pronates their forearm. Practitioner resists active forearm supination and flexion. Pain localised to bicipital groove area is a positive test.

Question 19

Explain the bear hug test

Answer 19

Patient places palmar surface of hand on contralateral shoulder with arm at 90 degrees horizontal flexion. Patient actively resists cephalic pressure exerted by practitioner on patient’s elbow (ie. resisted internal GH rotation). Pain and/or weakness in internal rotation is +ve.

Question 20

Explain the drop arm test

Answer 20

Patient is instructed to actively abduct their arm to 90 degrees. The patient is then instructed to slowly adduct the arm whilst the practitioner applies gentle caudal pressure. Test is positive if arm ‘drops’ at around 30 degrees abduction.

Question 21

Explain the painful arc sign

Answer 21

Patient is instructed to actively abduct shoulder and arm. Pain in the shoulder between 60 – 120 degrees abduction is considered a positive result.

Question 22

Explain Weak external rotation of Glenohumeral joint test

Answer 22

Patient stands with arm at side, elbow flexed to 90 degrees. Patient externally rotates arm (and therefore shoulder) against practitioner’s resistance. Weakness or inability to perform this test is considered positive. (specific for infraspinatus muscle)

Question 23

Explain the Hawkins-Kennedy Test

Answer 23

Practitioner stands at patient’s side and stabilizes scapula. Practitioner then flexes shoulder to 90 degrees, flexes elbow to 90 degrees and passively internally rotates GH joint by applying caudal pressure to posterior aspect of the wrist. Pain in the shoulder on internal GH rotation is considered positive for this test.

Question 24

Explain the Empty Can/Full can Test

Answer 24

Resisted abduction to 90 degrees with GH internally rotated then repeated with GH in external rotated. ie patient puts thumb down (empty can) and then thumb up (full can). Pain on internal rotation is considered a positive result for sub-acromial impingement . External rotation may, in fact, relieve pain

Question 25

Explain the Internal rotation resisted strength test (IRRST)

Answer 25

Patient abducts shoulder to 90 degrees and flexes elbow to 90 degrees. Practitioner applies resisted external rotation then internal rotation up to the physiological barrier. Test is +ve if internal rotation is weak and painful compared to external rotation.

Question 26

Explain Neers test

Answer 26

Practitioner stabilizes the shoulder, passively forward flexes arm in neutral rotation. This may be +ve where internal impingement is causing posterior shoulder pain.

Question 27

Explain the lift off test

Answer 27

Patient standing. Instruct patient to place hand behind back with dorsal surface of the hand against mid lumbar spine, and then to actively lift hand posteriorly away from spine. Failure to lift off hand is +ve test. (Note: abandon test if pain is felt whilst placing hand behind the back.)

Question 28

The Napoleon or Belly press test

Answer 28

Patient flexes elbow and pushes palmar surface of hand against epigastrium or umbilicus – this is a gentle version of the previous test and is less provocative if there are sub-acromial or GH complications. Pain in the shoulder is considered positive for this test

Question 29

Explain the scarf test

Answer 29

Patient’s hand is placed on contralateral shoulder and forcibly adducted whilst scapula is stabilized. Pain locally at the AC joint is a +ve test.

Question 30

Explain Paxinos test

Answer 30

Practitioner’s thumb is placed on posterior acromion with the 2nd or 3rd fingers of the same hand placed on

the distal portion of the clavicle. Practitioner’s thumb compresses in an antero-superior direction whilst the fingers compress the clavicle posteriorly. Pain at the AC joint is a +ve test. Good specificity and sensitivity.

Question 31

what are the two Tests for sub-acromial bursitis?

Answer 31

Painful arc test

Neers test