Upper Extremity Assessment Flashcards
What causes winged scapula?
Paralysis of the serrratus anterior from injury to the long thoracic nerve.
What direction does a glenohumeral dislocation happen in 95% of the time?
Anteriorly
What are the signs of a glenohumeral dislocation?
The arm is head in a position of protection and positive sulcus sign
What is the sulcus sign?
The Sulcus sign is an orthopedic evaluation test for glenohumeral instability of the shoulder
What muscle in the rotator cuff is responsible for abduction?
Supraspinatus
What muscles in the rotator cuff are responsible for external rotation?
80% infraspinatus, 20% teres minor
What muscle in the rotator cuff is responsible for internal rotation?
Subscapularis
How should you test muscle strength in the shoulders?
By testing the muscle strength against resistance
“Done let me push your arms down”
What is the painful arc test?
- passively adduct the arm from 0 to 180 degrees.
- Determine at what degree the patient has pain. It is a positive test if they have pain between 60 and 120 degrees
How do you test for Neers sign?
1) Stabilize scapula with one hand
2) Passively Raise extended arm in external and internal rotation
3) Observe for pain that is worse with internal rotation
What is a postive Neers sign?
Pain with internal rotation. The amount of impingement correlates with degree of flexion
- 90 degrees: Mild
- 60-70 degrees: Moderate
- 45 degrees: severe
How do you perform the Hawkins test?
- Stabilize the shoulder with one hand
- Flex the elbow to 90 degrees
- passively flex the shoulder to 90 degrees
- Internally rotate the shoulder
How do you test for the external lag sign?
1) Flex elbow to 90 degrees
2) Passively externally rotate shoulder fully
3) ask the patient to maintain the positive.
What is a positive external lag sign?
Inability to maintain position and resist antagonistic muscles
How do you perform the external rotation test?
1) Ask pt to flex elbows to 90 degrees in supination
2) Stabilize one arm
3) Apply internal pressure at wrist
4) Ask patient to externally rotate against resistance
Positive if pain or weakness is present
How do you perform the Gerber lift off test?
1) Patient seated or standing
2) Ask patient to rest dorsum of hand on low back/sacrum
3) Ask patient to lift off to increase amount of internal rotation
4) Apply gentle resistance to hand
What is a postive gerber lift off test?
Inability to lift off or maintain resistance
How do you perform the empty can (Jobes test)?
1) Passively forward flex shoulders while maintaining hyperpronation (thumbs down), elbow extension, and slight abduction
2) Ask patient to resist downward pressure
What is a positive empty can test and what can this indicate?
Inability to maintain resistance and may indicate supraspinatous injury or tear
How do you perform the drop arm test?
1) Passively abduct shoulder to 120 degrees
2) Ask patient to slowly lower arm back to side
What is a positive drop arm test?
Inability to fully abduct the arm or maintain a smooth transition back to side. Secondary weakness and/or pain
What are the tests that can evaluate for impingement syndrome?
Painful arc test, Neers sign, and Hawkins sign
What are the tests that can assess for rotator cuff tear?
External lag sign, external rotation resistance test, gerber lift off, empty can (Jobes test), and drop arm
What symptom should you be testing for if you are suspicious for rotator cuff tear?
Weakness
What symptom should you be testing for if you are suspicious for impingement syndrome?
Pain
What is adhesive capsulitis also known as?
Frozen shoulder
What is the presentation of adhesive capsulitis?
- Diffuse, dull, aching pain usually without localize tenderness
- Progressive restriction of ROM in multiple planes
- Usually unilateral