Upper extremity II: Physical exam of the shoulder

Question 1

relevant hx questions for shoulder PE

Answer 1

1. referred pain?

2. if not referred, is it structural?

Question 2

red flags for shoulder PE

Answer 2

1. infection
2. fracture
3. cancer
4. vascular
5. neuro

Question 3

what is the order of exam for shoulder PE?

Answer 3

1. inspect
2. active ROM (neck, shoulder)
3. passive ROM
4. resisted tests
5. special tests
6. palpation

Question 4

what are the deficiencies in capsular pattern of the shoulder?

Answer 4

1. some limitation of abduction
2. more limitation of external rotation
3. less limitation of internal rotation

Question 5

what are the steps of passive horizontal adduction? what structure does it test?

Answer 5

1. place hand on patient’s back to prevent trunk rotation
2. grasp arm at elbow and flex shoulder to 90
3. move patient’s arm horizontally across body
4. gently press patient’s elbow toward contralateral shoulder

AC joint

Question 6

what are the steps of hawkin’s test? what structure does it test?

Answer 6

1. place monitoring hand on shoulder
2. with other hand, passively flex elbow and shoulder to 90
3. passively internally rotate humerus to bring greater tubercle under AC joint

pinching structures between humerus and AC joint

Question 7

what are the steps of neer’s test? what structure does it test?

Answer 7

1. place monitoring hand on posterior shoulder
2. grasp elbow and internally rotate humerus to bring greater tubercle under AC joint
3. bring arm from near-full flexion to full flexion

pinching structures between humerus and AC joint

Question 8

what are the steps of the arm drop test? what structure does it test?

Answer 8

1. passively abduct patient arms to 180
2. release arms and ask to slowly lower arms to sides

180-90: adduction
90-0: supraspinatus

Question 9

what are the steps of the apprehension test? what structure does it test?

Answer 9

1. grasp wrist and flex elbow and shoulder to 90
2. bring flexed shoulder into horizontal abduction
3. apply pressure at wrist to fully externally rotate shoulder

anterior GH capsule for instability / laxity

Question 10

what are the steps of the relocation test? what structure does it test?

Answer 10

1. with arm still in abduction and external rotation, place a posteriorly directed force onto anterior aspect of humerus
2. positive if pressure relocating humerus within glenoid fossa relieves pain (anterior subluxation over a simple impingement)

head of humerus in glenoid fossa

Question 11

what are the steps of the empty can test? what structure does it test?

Answer 11

1. flex patient’s shoulders to 90
2. fully internally rotate arms - thumbs point down
3. move patient’s arms laterally 35-40 while maintaining flexion
4. place hands on the superior surface of wrists
5. apply downward pressure while the patient resists this motion

supraspinatus

Question 12

what are the steps of speed’s test? what structure does it test?

Answer 12

1. palpate long head of biceps at groove
2. place patient’s shoulder in partial forward flexion with elbow fully extended and forearm supinated so palm is up
3. physician pushes arm down against patient’s resistance

bicipital tendinitis

Question 13

what are the steps of yergason’s test? what structure does it test?

Answer 13

1. patient flexes elbow to 90
2. grab flexed elbow and wrist
3. externally rotate patient’s arm as patient resists while pulling inferiorly on elbow

biceps tendon subluxation