Thoracic/Shoulder Orthos

Question 1

Adam’s position

Answer 1

If scoliosis is present standing but reduces when patient flexes forward—functional
If scoliosis is present standing but does not reduce when patient flexes forward—structural

Question 2

Chest expansion

Answer 2

Normal chest expansion in men is 2+ inches and in women is 1+ inches
A decrease in chest expansion indicates an ankylosing condition

Question 3

Forestier’s

Answer 3

Normally the contralateral musculature demonstrates tightness
Patients with ankylosing spondylitis will demonstrate ipsilateral tightening of paraspinal muscles

Question 4

Schepelmann’s Sign

Answer 4

Pain created on concavity —suspect intercostal neuritis
Pain created on convexity —suspect intercostal myofascitis

Question 5

Rib Compression

Answer 5

A-P: pain indicates fracture, contusion, or costochondral separation
Lateral: pain indicates fracture

Question 6

Sternal Compression

Answer 6

Localized pain along the lateral border of the ribs indicates fracture

Question 7

Dugas

Answer 7

Inability to touch opposite shoulder or unable to lower arm to chest indicates anterior dislocation of humerus

Question 8

Apley’s scratch test

Answer 8

Exacerbation of pain in the shoulder indicates degenerative tendinitis of the rotator cuff usually supraspinatus tendon

Question 9

Subacromial push button

Answer 9

An increase in pain indicating a subacromial bursitis

Question 10

Dawbarn’s sign

Answer 10

Decrease in tenderness or pain indicating subacromial bursitis

Question 11

Apprehension test

Answer 11

Pain over anterior capsule + look of apprehension on patient’s face or laxity compared to the other side indicates anterior dislocation trauma of the humerus

Question 12

Relocation test (if apprehension is +)

Answer 12

If patient experiences relief of symptoms that manifested during the apprehension test it indicates anterior instability
If no change in pain—another cause

Question 13

Sulcus sign

Answer 13

Sulcus or dimpling appearing superior to humeral head/inferior to lateral acromion indicates multidirectional instability

Question 14

Load & Shift (shoulder drawer test)

Answer 14

Increased movement and/or popping grinding or slapping indicates instability of glenohumeral joint and possible labrum damage

Question 15

Arm drop test (Codman’s test)

Answer 15

Pain and hunching of shoulder indicating rotator cuff tear or rupture of the supraspinatus tendon

Question 16

Empty can

Answer 16

Weakness or pain indicates a lesion of the supraspinatus muscle or tendon

Question 17

Lift off test

Answer 17

Weakness and or pain indicates a lesion of the subscapularis muscle or tendon

Question 18

Yergson’s

Answer 18

Pain or tenderness over bicipital tendon and the transverse humeral ligament. Indicative of tenosynovitis of the humeral ligament, inflammation of the biceps tendon, or tendinitis. If popping occurs, suspect laxity of transverse humeral ligament or congenital shallow bicipital groove

Question 19

Clunk

Answer 19

Clicking or clunking with or without pain indicates labrum tear

Question 20

Crank

Answer 20

Clicking without or without pain indicates labrum tear

Question 21

O’Brien’s sign

Answer 21

If the patient experiences deep pain in the shoulder with internal rotation which is reduced or eliminated with external rotation it indicates a torn glenoid labrum

Question 22

Hawkins-Kennedy

Answer 22

Pain in the anterior glenohumeral joint is indicative of rotator cuff tendinitis and possible impingement of supraspinatus

Question 23

Neer’s test

Answer 23

Pain in the anterior glenohumeral joint is indicative of rotator cuff tendonitis

Question 24

Impingement relief

Answer 24

Decrease in pain or alleviation indicates mechanical impingement under the acromion