what are you assessing for when palpating a nodule
- tenderness
- mobile/fixed
- soft/hard
Loss of contour of normally rounded shoulder. What condition do you suspect
dislocation of shoulder
Examination reveals this. What do you suspect
- paralysis of serratus anterior
- injury to long thoracic nerve
what test is this?
sulcus sign: indicates glenohumeral instability of the shoulder
- arm in neutral relaxed position, provider will pull the arm downward
what percentage of shoulder dislocations are anterior vs posterior
- 95% anterior (pictured
- 5% posterior
If there is injury to rotator cuff muscles, what is the likely order in which the muscles will be torn
SITS
- Supraspinatous
- Infraspinatus
- Teres Minor
- Subscapularis
What rotator cuff muscle is responsible for abduction of shoulder
supraspinatous
Which rotator cuff muscle is responsible for internal rotation of shoulder
subscapularis
Which muscles are responsible for external rotation of shoulder
- 80% infraspinatus
- 20% teres minor
What test goes with the maneuver: patient touches superior and inferior aspects of opposite scapula? What diagnosis is suggested by a positive result?
- apley scratch test
- loss of range of motion: rotator cuff problem
How can you test for a supraspinatous injury/tear
- empty can test
- resistance against forward flexion in hyperpronation (thumbs down), elbow extension, and abduction
How would test for a subscapularis injury/tear
- Lift off test
- place hand on the back with shoulder internally rotated
- push against resistance
How would you test for a rotator cuff injury
- Drop arm test
- poriver passively abduct arm to 120 degrees and asks the patient to slowly lower his/her arm
- positive test: inability to complete this secondary to pain
what is impingement syndrome
impingement of tendons or bursa in the shoulder from bones of the shoulder
How can you test for impingement sydrome
have patient raise arms laterally to side
- patient will not feel pain for the first 70 degrees
- patient will feel pain from 70 to 120 degrees
- if you guide patient’s arm above 120 degrees, patient will not feel pain above 120 degrees
How would you test for supraspinatous tendon impingement
- Hawkin’s test
- passive flexion to 90 degrees and forceful internal rotatation of the shoulder
- look for pain
How would you test for subacromial impingment
- neer’s sign
- passive flexion with arm pronated and scapula is stabilized
- look for pain
How would you test for biceps tendon instability or tendonitis
- Yergason test
- flex elbow at 90 degress with forarm pronated
- supinate forearm and externally rotate humerus against resistance
What is another method, other than Yergason test, to test for Biceps tendonitis
- Speed’s test
- arm extended in full supination with shoulder flexed. Elevate arm against resistance
How would you test for anterior glenohumeral instability
- apprehension and relocation test
- elbow flexed at 90 degress, arm abducted at 90 degress
- apply external rotation at the shoulder and note apprehension
- Notice if there is pain and apprehension with ROM testing and if pain is relieved with relaxation/relocation
how would you test for acromioclavicular joint arthritis
- cross body adduction test
- forward elevation to 90 degress and active adduction
clinical symptoms
- diffuse, dull, aching pain
- usually no localized tenderness
- progressive restriction of ROM
- usually unilateral
adhesive capsulitis (frozen shoulder)
clinical symptoms
- localized pain and swelling to medial aspect of elbow
- reproducible pain with wrist flexion against resistance
medial epicondylitis: golfer’s elbow
- flexor pronator muscle group
clinical symptoms
- localized pain and swelling to lateral aspect of elbow
- reproducible pain with wrist extension against resistance
lateral epicondylitis: tennis elbow
- extensor supinator muscle group
