S3- Musculoskeletal > Shoulder Complex Examination > Flashcards

Shoulder Complex Examination Flashcards

(57 cards)

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1
Q

What is the order of the differential diagnosis process?

A
  1. ) Chart Review/ Patient Interview
  2. ) Visual Inspection
  3. ) Systems Review
  4. ) Elimination Tests
  5. ) Structural Stress Testing
  6. ) Palpation and Joint Mobility Tests
  7. ) Confirmation Tests
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2
Q

PATIENT INTERVIEW

A

PATIENT INTERVIEW

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3
Q

What are some screening questions to ask for the shoulder complex?

A
  • UE Trauma; specify mechanism
  • Hx neck pain/trauma
  • Hx shoulder dislocation
  • DM
  • Hx frozen shoulder
  • Pain referral from cardiopulmonary systems
  • UE paresthesia/anesthesia/weakness
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4
Q

What are some common functional limitations of patients with shoulder issues?

A
  • lifting/carrying objects
  • pushing/pulling
  • reaching behind back/overhead/away from body
  • prolonged positioning
  • sleeping
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5
Q

What are some outcome measures used to assess shoulder involvement?

A
  • PSFS
  • DASH and QuickDASH (Disabilities of the Arm, Shoulder, and Hand)
  • SPADI (Shoulder Pain and Disability Index)
  • WOSI (Western Ontario Shoulder Instability Index)
  • PSS (Penn Shoulder Score)
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6
Q

VISUAL INSPECTION

A

VISUAL INSPECTION

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7
Q

What are we looking for during a visual inspection of the shoulder?

A
  • Gross abnormalities
  • Integumentary
  • Resting posture vs ability to correct
  • Posture Assessment
  • Scapulohumeral rhythm during elevation
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8
Q

What are some gross abnormalities we might see at the shoulder?

A
  • step-off deformity at ACJ
  • deformity of clavicle
  • deformity at SCJ
  • bulging posterior shoulder
  • self-supporting the UE
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9
Q

With a postural assessment, what structures are we looking at?

A
  • head on neck
  • mandible on cranium
  • neck on trunk
  • scapulae on thorax (“winging” or “hiking”)
  • upper arms on scapulae (resting ER)
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10
Q

What comes after the visual inspection?

A

Systems Review

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11
Q

ELIMINATION TESTS

A

ELIMINATION TESTS

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12
Q

What screening tests are performed both at the neck and shoulder?

A
  • UQ screen
  • Neuro screen
  • Special tests w/ -LR
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13
Q

What elimination tests are used to rule out radiculopathy?

A

ULTT

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14
Q

What elimination tests are used to rule out fracture/bony abnormality?

A
  • Bony Apprehension Test

- Olecranon-Manubrium Percussion Test

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15
Q

What elemination test is used to rule out SLAP lesion/ Labral tear?

A

Active Compression Test (O Brien Test)

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16
Q

What elimination test is used to rule out ACJ dysfunction?

A

AC Joint Palpation

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17
Q

Why would a ULTT be used when assessing the shoulder?

A
  • Decrease suspicion of c-spine origin for UE symptoms
  • Sway focus to further testing to investigate origin of symptoms at neck or locally at the shoulder
  • Increase confidence that we can move on from further testing at the neck
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18
Q

Bony Apprehension Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Anterior instability of shoulder due to bony lesion
  • Pt Position: Sitting
  • Examiner Position: Grasping proximal forearm and elbow to support, starting in 90 degrees of pt elbow flexion
  • Procedure: Abduct the patient’s shoulder to 45 (or less)degrees then externally rotate the shoulder to 45 degrees (or less)
  • Positive Test: Apprehension with the test
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19
Q

Olecranon-Manubrium Percussion Test:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Fracture/dislocation between elbow and manubrium
  • Pt Position: Sitting/standing with arms crossing chest
  • Examiner Position: Beside/facing patient
  • Procedure: Percuss the olecranon while auscilating the manubrium. Repeat on non-involved side.
  • Positive Test: Difference in sound quality between tested sides
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20
Q

Active Compression Test (O’Brien Test):

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: Labral tear or abnormality/ SLAP lesion/ ACJ pathology
  • Pt Position: Standing w/ elbow straightened and shoulder at 90° flexion, 10° horizontal adduction, and max IR
  • Examiner Position: Standing behind patient
  • Procedure: Patient resists isometric extension moment placed on wrist. Pt moves to maximum ER and resists isometric extension moment placed on wrist again.
  • Positive Test: Pain and clicking in IR position > pain in ER position
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21
Q

AC Joint Palpation:

  • Indications?
  • Pt Position?
  • Examiner Position?
  • Procedure?
  • Positive test?
A
  • Indications: AC joint dysfunction
  • Pt Position: Sitting with arm at side
  • Examiner Position: Standing behind patient
  • Procedure: Palpate ACJ line
  • Positive test: concordant pain provocation
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22
Q

STRUCTURAL STRESS TESTING

A

STRUCTURAL STRESS TESTING

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23
Q

Structural stress testing AROM can be done in _______ or ________. With this we want to observe ____________ and ________ spine motions.

Study These Flashcards
A
  • sitting or supine

- scapulothoracic and thoracic spine

24
Q

What movements are performed during AROM and PROM assessment?

Study These Flashcards
A
  • flexion/extension
  • abduction/adduction
  • IR/ER
25
Muscle length testing of what can be performed during structural stress testing?
- Lats - Pec Minor - Levator Scap/ posterior scalene/ splenius cervicis - Upper trap/ SCM
26
With AROM/PROM and Resistive testing, what 4 things are we assessing for?
- Quality - Quantity - Provocation - Willingness to move
27
What scapular MMT tests can be assessed during structural stress testing?
- Abduction and upward rotation - Elevation - Adduction - Depression and adduction
28
What shoulder MMT tests can be assessed during structural stress testing?
- flexion/extension - abduction - horizontal ab/adduction - IR/ER
29
PALPATION AND JOINT MOBILITY TESTS
PALPATION AND JOINT MOBILITY TESTS
30
List the palpable bone and joint structures of the shoulder.
- Clavicle - SC joint line - AC joint line - Coracoid process - Humerus (greater/lesser tuberosity, head) - Spine of scapula - Acromion - Sternum - Ribs/Costal cartilage
31
List the palpable soft tissue structures of the shoulder.
- Sub-Acromial Space - Supraspinatus tendon and muscle belly - Subscapularis tendon and muscle belly - Infraspinatus tendon and muscle belly - Supraspinatus tendon and muscle belly - Long head of biceps tendon - Deltoid muscle belly - Trapezius - Pec major/minor
32
What joints can we apply joint mobilizations to in the shoulder?
- GH - Scapulothoracic - SC - AC
33
Joint Mobility: - The GH joint has a ______, ______, and ______ glide. - The SC joint has a _______, ______, and ______ glide. - The AC joint has a _______ glide.
- caudal, dorsal, and ventral - caudal, dorsal, and ventral - anterior
34
Describe the scapulothoracic glides. - Patient Position? - Examiner Position? - Procedure?
Patient Position -side-lying, 90° elbow flexion Examiner Position -facing patient's anterior trunk -caudal UE: reaching medial to upper arm, support inferior angle of scapula -Cranial UE: superior scapula Procedure -passively bring scapula through depression, elevation, retraction, upward rotation, and downward rotation -*move scapula and humerus as a unit -*ensure shoulder girdle musculature is relaxed
35
- For the dorsal (posterior) glide of the SC joint we push on the _______. - For the ventral (anterior) glide of the SC joint we push on the _______. - For the caudal glide of the SC joint we apply a caudal force on the medial _______ in a slight _______ and _______ direction.
- clavicle - manubrium - clavicle, anterior and lateral
36
For the ventral (anterior) glide of the AC joint we apply a ventral force on the ________ while the patient is sitting.
clavicle
37
CONFIRMATION TESTS
CONFIRMATION TESTS
38
What confirmation tests are used for rotator cuff tear?
- External Rotation Lag Sign - Lift-Off Test - Internal Rotation Lag Sign - Empty can Test - Belly Press Test - Drop Arm Test - Infraspinatus Test
39
External Rotation Lag Sign: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: Sitting - Examiner Position: Behind patient with medial hand stabilizing patient UE at elbow, and lateral hand grasping patients wrist - Procedure: Passively places elbow in 90° flexion and shoulder in 20° scaption, passively externally rotate shoulder to near-end-range and ask patient to maintain position - Positive test: Inability to maintain shoulder in externally rotated position
40
Lift Off Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: sitting, tested UE behind pt's back with dorsum of wrist/hand contacting posterior trunk - Examiner Position: posterior for observation - Procedure: pt instructed to lift arm off back - Positive test: inability to lift arm off of the back
41
Internal Rotation Lag Sign: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: sitting, tested UE behind pt's back - Examiner Position: behind stabilizing patient's elbow wth more lateral UE, grasping patient's wrist with more medial UE - Procedure: pt's UE lifted away from back (passive IR), pt instructed to maintain position - Positive test: inability to maintain position
42
Empty Can Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: sitting, edge/corner of table - Examiner Position: behind pt - Procedure: pt elevates shoulder to 90° scaption, isometric extension moment placed at wrists in thumbs-up and thumbs down position - Positive test: weakness and/or pain in thumbs-down position (relative to thumbs-up)
43
Belly Press Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: sitting, elbow flexed 90°, palm on abdomen - Examiner Position: standing in front of patient - Procedure: patient internally rotates shoulder to press hand into abdomen - Positive test: elbow drops into extension
44
Drop Arm Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: sitting - Examiner Position: behind pt on symptomatic side - Procedure: grasping at the wrist, examiner passively abducts the shoulder to 90°, examiner then releases the UE with instruction to slowly lower the UE - Positive test: inability to lower the arm
45
Infraspinatus Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Rotator Cuff Tear - Pt Position: standing, elbow flexed to 90° and neutral rotation - Examiner Position: behind on symptomatic side - Procedure- supporting the pt elbow, examiner applies an internal rotation force at the wrist - Positive test- pain or weakness with resistance
46
What are the 4 components of the Rotator Cuff Tear Diagnostic Cluster?
- Age >60 years - Painful Arc - + Drop Arm Test - + Infraspinatus Test
47
What confirmation tests are used for Torn Labrum/ Instability?
- Biceps Load II Test - Yeargaon's Test - Crank Test - Speed's Test - Modified Relocation Test
48
Biceps Load II Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: SLAP Lesion - Pt Position: supine - Examiner Position: symptomatic side - Procedure: shoulder passively placed in 120° abduction and end-range ER, elbow 90° flexion, forearm supinated. Examiner resists isometric elbow flexion - Positive test: concordant pain provocation with resisted elbow flexion
49
Yergason's Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: SLAP Lesion/ labral lesion - Pt Position: sitting or standing, 90° elbow flexion, forearm pronation - Examiner Position: patients symptomatic side - Procedure: pt instructed to supinate forearm while examiner resists this motion at the wrist - Positive test: concordant pain provocation at bicipital groove
50
Crank Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: Labral Tear - Pt Position: supine - Examiner Position: facing patient on symptomatic side - Procedure: examiner passively abducts shoulder to 160° and flexes elbow 90°, axial compression imposed on upper arm in line with long axis of humerus, repeated IR/ER passively performed (small motions) - Positive test: concordant pain provocation
51
Speed's Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: subacromial impingement, SLAP lesion, labral lesion, biceps pathology - Pt Position: standing, elbow extended, forearm supinated - Examiner Position: standing, facing patient - Procedure: shoulder flexion resisted from 0° to 60° of motion - Positive test: concordant pain provocation in bicipital groove
52
Modified Relocation: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications:labral pathology, traumatic anterior instability - Pt Position: supine - Examiner Position: standing beside patient - Procedure: shoulder passively abducted to 120° and full ER, anterior force applied to posterior humeral head. If painful, a posterior force is applied to anterior humeral head - Positive test: pain and/or apprehension
53
What confirmation test is used for AC joint dysfunction?
AC Resisted Extension Test
54
AC Resisted Extension Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: AC Joint Pathology - Pt Position: sitting - Examiner Position: standing - Procedure: patient placed in 90° shoulder flexion and IR, 90° elbow flexion. Examiner resists shoulder horizontal abduction - Positive test: concordant pain provocation at AC joint line
55
What confirmation tests are used for impingement/RC tear?
- Hawkins-Kennedy Test | - Neer Test
56
Hawkins-Kennedy Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: subacromial impingement, RC integrity, superior labral tear - Pt Position: seated, elbow flexed to 90° - Examiner Position: standing, anterior to involved shoulder - Procedure: passively elevate shoulder to 90° of shoulder flexion or abduction (stabilize scapula superiorly with other hand) - Positive test: concordant shoulder pain provocation
57
Neer Test: - Indications? - Pt Position? - Examiner Position? - Procedure? - Positive test?
- Indications: subacromial impingement - Pt Position: seated, elbow extended - Examiner Position: standing to side of patient - Procedure: passively flex the arm with one hand while stabilizing the scapula with the other hand, apply overpressure for flexion at end-range - Positive test: concordant shoulder pain provocation
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