Shoulder anatomy-history 110 : observation 160 : examination 340 : tests 835

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Which of the following is a prerequisite to any treatment of a patient with shoulder pain?

A comprehensive picture of the signs and symptoms

What can cause shoulder pain?

All of the above

Why is the assessment of the shoulder complex difficult?

All of the above

What influences make the examination of the shoulder region even more difficult?

All of the above

Which structures should be evaluated in addition to the shoulder region?

Both A and B

What factor can play a significant role in the pathology of the shoulder?

Both A and B

Which ligament controls the vertical motion of the clavicle?

Interclavicular ligament

What is the resting position of the acromioclavicular joint?

90 degrees adduction

Which nerve innervates the sternoclavicular joint?

Suprascapular nerve

What is the main ligament maintaining the integrity of the sternoclavicular joint?

Costoclavicular ligament

Which joint enables the humerus in the glenoid to move through a full 180 degrees of abduction?

Sternoclavicular joint

What is the resting position of the scapulothoracic joint?

90 degrees adduction

Which age group is most likely to experience rotator cuff degeneration?

Between 40 and 60 years

What are indicative factors of rotator cuff tears?

External rotation weakness, night pain, and age over 65

What age group is primary impingement usually seen in?

Over 65 years

What age group is secondary impingement more common in?

Under 20 years

At what age may calcium deposits occur?

Between 20 and 40 years

At what age is frozen shoulder resulting from causes other than trauma seen?

Between 45 and 60 years

Which ligament is the most important in stabilizing the glenohumeral joint?

Inferior glenohumeral ligament

Which ligament limits lateral rotation between 45° and 90° of abduction?

Middle glenohumeral ligament

Which ligament limits inferior translation in adduction and restrains anterior translation and lateral rotation up to 45° of abduction?

Superior glenohumeral ligament

What ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Coracohumeral ligament

What ligament forms an arch over the humeral head, acting as a block to superior translation?

Coracoacromial ligament

What is the most limited motion of the glenohumeral joint according to the capsular pattern?

Lateral rotation

Which joint primarily depends on muscles and ligaments for its support, stability, and integrity?

Glenohumeral joint

What is the function of the labrum in the glenohumeral joint?

All of the above

What is the resting position of the glenohumeral joint?

55° of abduction and 30° of horizontal adduction

What is the close packed position of the glenohumeral joint?

Full abduction and lateral rotation

What is the angle of torsion in the humeral head relative to the line joining the epicondyles?

25° to 30°

Which athletes commonly have greater retrotorsion in the humeral head?

Pitchers

Which age group is most likely to experience rotator cuff degeneration?

Between 40 and 60 years

What is the most limited motion of the glenohumeral joint according to the capsular pattern?

Internal rotation

What is the angle of torsion in the humeral head relative to the line joining the epicondyles?

0 degrees

What is the function of the labrum in the glenohumeral joint?

To provide stability to the joint

What factor can play a significant role in the pathology of the shoulder?

Age

What is the main ligament maintaining the integrity of the sternoclavicular joint?

Sternoclavicular ligament

At what age may calcium deposits occur?

Between 20 and 30 years

At what age is frozen shoulder resulting from causes other than trauma seen?

Between 45 and 60 years

What can cause shoulder pain?

All of the above

What influences make the examination of the shoulder region even more difficult?

All of the above

Which of the following is a common cause of shoulder pain?

All of the above

What makes the assessment of the shoulder complex difficult?

All of the above

Which age group is most likely to experience shoulder impingement?

Middle-aged adults

Which structures should be evaluated in addition to the shoulder region?

Cervical spine and thoracic spine

What is the most limited motion of the glenohumeral joint according to the capsular pattern?

Internal rotation

What factor can play a significant role in the pathology of the shoulder?

Age

Which ligament supports the acromioclavicular joint anteriorly and posteriorly?

Interclavicular ligament

Which joint is responsible for controlling the movements of the scapula?

Scapulothoracic joint

Which nerve innervates the sternoclavicular joint?

Anterior supraclavicular nerve

What is the resting position of the sternoclavicular joint?

Same as the acromioclavicular joint

Which ligament prevents medial displacement of the clavicle in the sternoclavicular joint?

Anterior sternoclavicular ligament

What is the main function of the scapulothoracic joint?

Controlling movements of the scapula

Which ligament helps to stabilize the long head of the biceps as it passes over the joint line?

Superior glenohumeral ligament

What is the angle between the humeral neck and shaft in adults?

130°

What is the resting position of the glenohumeral joint?

55° of abduction and 30° of horizontal adduction

What is the function of the labrum in the glenohumeral joint?

All of the above

What is the relative position of the humeral head and the axis of the elbow at the distal humerus called?

Humeral torsion

Which muscles and ligaments primarily support the glenohumeral joint?

Muscles and ligaments

Which age group is most likely to experience rotator cuff degeneration?

Middle-aged adults

What is the age range in which rotator cuff tears are more likely to be seen?

Over 65 years

What are indicative factors of rotator cuff tears?

Positive painful arc sign, positive drop-arm sign, and weakness in shoulder lateral rotation

What is the age range in which primary impingement due to degeneration and weakness is usually seen?

35 years and above

What age group is secondary impingement due to instability caused by weakness in the scapular or humeral control muscles more common in?

Young adults

At what age may calcium deposits occur?

40-60 years

Which ligament is the primary support of the acromioclavicular joint?

Coracoclavicular ligament

What is the primary role of the superior glenohumeral ligament?

Limiting inferior translation in adduction

Which ligament limits lateral rotation between 45° and 90° of abduction?

Middle glenohumeral ligament

Which ligament is the most important in stabilizing the shoulder?

Inferior glenohumeral ligament

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Inferior glenohumeral ligament

Which ligament helps to stabilize the long head of biceps and limits inferior translation of the acromioclavicular joint?

Coracohumeral ligament

Which age group is primary impingement usually seen in?

Adults

What is the age range when calcium deposits may occur?

20-30 years

What is the age range when chondrosarcomas may be seen?

30-40 years

What is the age range when frozen shoulder resulting from causes other than trauma is seen?

45-60 years

What is the age range when overuse damage to the proximal humeral physis may be seen?

10-20 years

What is the mechanism of injury when the patient falls on or receives a blow to the tip of the shoulder?

Acromioclavicular dislocation or subluxation

What does it mean when the patient supports the upper limb in a protected position or hesitates to move it?

Unstable shoulder complex

What is the primary support of the acromioclavicular joint?

Acromioclavicular ligament

What ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Superior glenohumeral ligament

What ligament forms an arch over the humeral head, acting as a block to superior translation?

Superior glenohumeral ligament

Which movement may cause pain in the shoulder due to cervical spine movements?

Lateral rotation

What muscle tends to be overactive during elevation activities with subacromial impingement?

Pectoralis minor

What should be asked regarding instability of the shoulder?

All of the above

What should be asked if the patient complains of pain with overhead activity, especially if the patient is an athlete?

Both a and b

What movement may cause pain in an unstable and painful shoulder when the hand is placed behind the head with the elbow backward?

Medial rotation

What movement may cause pain in an unstable and painful shoulder when carrying a heavy weight with the arm extended along the body?

Lateral rotation

What movement may cause pain in recurrent dislocators when the humeral head is 'tightened' against the anterior glenoid?

Medial rotation

What type of pain may be caused by pathology of the long head of biceps?

Anterior pain

What movement may cause pain in the shoulder due to cervical spine movements?

Lateral rotation

What muscle tends to be overactive during elevation activities with subacromial impingement?

Pectoralis minor

Which of the following symptoms may indicate vascular involvement in the upper limb?

Swelling and stiffness

Which condition may lead to thoracic outlet syndrome, axillary artery occlusion, effort thrombosis, or pressure in the quadrilateral space?

Dislocation of the glenohumeral joint

Which nerve may be injured as it passes through the suprascapular notch, leading to atrophy and paralysis of the supra- and infraspinatus muscles?

Suprascapular nerve

Which nerve injury may result in atrophy and weakness or paralysis of the deltoid and teres minor muscles?

Axillary (circumflex) nerve

Which nerve injury may affect the extensors of the elbow, wrist, and fingers, as well as alter sensation in its sensory distribution?

Radial nerve

Which shoulder is usually lower than the nondominant shoulder and may have a different range of motion?

Dominant shoulder

What is the main function of the scapulothoracic joint?

To allow movement of the scapula on the thorax

Which ligament limits lateral rotation between 45° and 90° of abduction?

Inferior Glenohumeral Ligament

Which structures should be evaluated in addition to the shoulder region?

The entire upper limb

Which of the following symptoms may indicate nerve injury in the shoulder region?

Paresthesia and numbness

Which of the following is a common cause of the dead-arm syndrome, characterized by sudden paralyzing pain and weakness in the shoulder?

Excessive abduction and lateral rotation

What is the term used to describe altered shoulder mechanics, commonly involving a tight posterior capsule, altered arthrokinematics of the glenohumeral joint, and scapular dyskinesia?

SICK scapula

What is the term used to describe pain during specific phases of pitching, indicating anterior instability even in the presence of minimal clinical signs?

Primary impingement

What is the term used to describe pain that is often related to rotator cuff tears and on occasion to tumors, and is typically worse at night?

Resting pain

Which of the following is a common cause of paratenonitis or tendinosis, often seen in skiers and cross-country skiers?

All of the above

Which of the following activities may indicate nerve root pain in the shoulder?

Elevating the arm over the head

Which of the following activities may exacerbate shoulder problems in patients with instability or inflammatory conditions?

Lifting the arm over the head

Which of the following signs could indicate an injury to the sternoclavicular joint or a posterior dislocation of the joint?

All of the above

Which of the following factors is important to determine in swimmers and baseball pitchers to assess shoulder problems?

All of the above

What is the term used to describe chronic overuse damage to the structures of the shoulder in elite swimmers?

Repetitive microtrauma

Which muscle provides an origin for the rotator cuff muscles as well as the biceps and triceps muscles?

Trapezius

What can cause inflammation of the paratenon in the shoulder?

Wide bicipital groove

What may snapping or clunking sound during abduction and adduction indicate in the shoulder?

Scapular dyskinesia

What can atrophy of the upper trapezius indicate in the shoulder?

Spinal accessory nerve palsy

What can atrophy of the supraspinatus or infraspinatus indicate in the shoulder?

Supraspinous nerve palsy

What is the term used to describe abnormal positions of the scapula like tilting, winging, or dysrhythmia?

Scapular dysfunction

What is the most common anomalous muscle in the axillary fossa?

Langer Axillary Arch

What deformity may be caused by an acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process?

Step deformity

What may an anterior dislocation of the glenohumeral joint result in?

Flattening of the deltoid muscle

What may a sulcus deformity indicate?

Inferior subluxation of the glenohumeral joint

What may a forward head posture be associated with?

All of the above

What may a step deformity indicate?

Acromioclavicular and coracoclavicular ligament tears

Which muscle is primarily responsible for winging of the scapula during abduction and forward flexion?

Serratus anterior

What is the most common congenital deformity of the shoulder complex?

Sprengel's deformity

Which nerve palsy can cause winging of the scapula at rest?

Long thoracic nerve palsy

Which muscle should be checked for wasting in cases of winging of the scapula?

Supraspinatus and infraspinatus muscles

What is the main cause of static winging of the scapula?

Structural deformity of the scapula

Which condition is characterized by a developmental deformity leading to a high or undescended scapula?

Sprengel's deformity

What is the term used to describe the altered sequencing of muscle activation patterns and muscle performance and length that help stabilize the scapula along with inhibition due to pain?

Scapular dyskinesia

Which movement pattern of scapular dysfunction is characterized by the whole medial border of the scapula being prominent and lifting away from the posterior chest wall both statically and dynamically?

Type II

What is the term used to describe the scapular movement pattern in which the superior border of the scapula is elevated at rest and during movement, with minimal winging and initiation of movement by a shoulder shrug?

Scapular winging

What is the term used to describe the scapular movement pattern in which both scapulae are symmetrical at rest and during motion, rotating symmetrically upward with the inferior angles rotating laterally away from midline?

Scapular control

What is the term used to describe scapular winging that is the result of muscle weakness of one of the scapular muscle stabilizers, disrupting the normal muscle force couple balance of the scapulothoracic complex?

Primary scapular winging

What is the term used to describe scapular winging that occurs because of pathology in the glenohumeral joint, altering the normal movement of the scapula?

Secondary scapular winging

Which of the following is NOT a reason why it is important to observe the patient as they undress and dress during a shoulder examination?

To observe if the patient can assume a 'neutral pelvis' position

Which of the following is NOT a potential vasomotor change that may be observed in the hand during a shoulder examination?

Hair loss

Why is it important to assess the patient's ability to assume a 'neutral pelvis' position during a shoulder examination?

To evaluate abnormal scapulothoracic, glenohumeral, and cervical spine positions

What percentage of the force of throwing is normally generated by the lower quadrant or kinetic chain?

50%

Which of the following questions should be asked by the examiner related to the 'neutral pelvic' position during a shoulder examination?

Can the patient hold the static neutral pelvis position while making distal dynamic movements?

What can an abnormal pelvic position during a shoulder examination lead to?

Alteration in the kinetic chain

Which muscle provides an origin for the rotator cuff muscles as well as the biceps and triceps muscles?

Pectoralis major muscle

What is the term used to describe abnormal positions of the scapula such as tilting, winging, or dysrhythmia?

Scapular dyskinesia

What can atrophy of the supraspinatus or infraspinatus muscles indicate in the shoulder?

Supraspinous nerve palsy

What may snapping or clunking sound during abduction and adduction of the shoulder indicate?

Posterior positional instability

Which of the following may indicate an acromioclavicular dislocation?

A step deformity

What may a sulcus deformity indicate?

Multidirectional instability

What may a flattening of the deltoid muscle area indicate?

Anterior dislocation of the glenohumeral joint

What may an elevated dominant side indicate?

Extra use of the dominant side

Which muscle is responsible for winging of the scapula during abduction and forward flexion?

Serratus anterior

Which condition is the most common congenital deformity of the shoulder complex?

Sprengel's deformity

Which nerve palsy can cause winging of the scapula at rest?

Long thoracic nerve palsy

Which muscles should be evaluated for wasting in cases of scapular winging?

Serratus anterior and trapezius muscles

During a shoulder examination, the examiner should observe the patient as they undress and dress. Which of the following actions by the patient may indicate possible pathology in the affected arm?

The patient undresses the affected arm last.

What is the role of kinematics in a shoulder examination?

Kinematics evaluates the patient's ability to generate force in the lower quadrant.

What is the importance of assessing the patient's ability to assume a 'neutral pelvis' position during a shoulder examination?

It indicates whether the patient has an abnormal pelvic position.

What percentage of the force of throwing is normally generated by the lower quadrant or kinetic chain?

50%

Which type of scapular dysfunction is characterized by the superior border of the scapula being elevated at rest and during movement, with minimal winging and initiation of movement by a shoulder shrug?

Type III

What is the primary cause of Type II scapular dysfunction?

Weak muscles in the lower trapezius, latissimus dorsi, and serratus anterior

What is the main difference between primary scapular winging and secondary scapular winging?

Primary scapular winging is caused by muscle weakness, while secondary scapular winging is caused by glenohumeral joint pathology.

What is the common cause of dynamic scapular winging with reverse scapulohumeral rhythm?

Multidirectional instability

Which structures may cause a painful arc in the shoulder?

Subacromial bursa

What is the most common cause of a painful arc in the shoulder?

Subacromial bursitis

What is the range of abduction where the pinching of structures under the acromion process occurs, resulting in pain?

60° to 120°

What is the common pattern of pain during a painful arc in the shoulder?

Greater going up than coming down

What is the movement that may decrease the pain during a painful arc in the shoulder?

Forward flexion

What are the signs and symptoms of a painful arc in the shoulder?

Painful arc sign, drop-arm test, infraspinatus test

Which of the following is true about the examination of the shoulder?

The examination includes an assessment of the cervical spine.

Which motion of elevation is considered the most natural and functional?

Elevation through scaption

In which type of kinetic chain does the arm act as an open kinetic chain?

Open kinetic chain

What is the angle of elevation in scaption determined by?

The contour of the chest wall

Which of the following is an example of scapular instability in a closed kinetic chain?

The rotator cuff muscles work in reverse order.

What is the main advantage of elevation in scaption compared to elevation through abduction?

Less stress on the capsule and surrounding musculature

What is the range of scapular rotation in scaption elevation?

About 65°

In an open kinetic chain, when should the scapular muscles be working eccentrically?

When the scapula must be stabilized

What is the range of humeral abduction in scaption elevation?

About 105°

What is the main function of the shoulder in the kinetic chain?

Force delivery

What is the normal range of active lateral rotation in the glenohumeral joint?

80° to 90°

Why is knowledge of muscle balance and force couples important in determining a diagnosis?

To understand the effects of kinetic chains on the shoulder

Which of the following is considered an open-kinetic-chain activity?

Reaching

What is the purpose of comparing one side of the body with the other during an assessment?

To determine individual differences among normal people

What is the term used to describe the combination of glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular movements in shoulder movements?

Glenohumeral function

What can compensatory scapular movement during active shoulder movements lead to?

All of the above

What is the term used to describe the premature excessive elevation or protraction of the scapula during arm lowering?

Scapular dysrhythmia

How does a slouched (rounded shoulder) posture affect the range of motion at the shoulder?

Increases medial rotation of the scapula

During phase 2 of scapulohumeral movement, the clavicle rotates posteriorly, retracts, and minimally elevates at the sternoclavicular joint. At the acromioclavicular joint, the clavicle tilts posteriorly and upwardly and rotates medially. How much motion is possible at the acromioclavicular joint during the rotation of the scapula?

20°

During the final 90° of motion (third phase) of scapulohumeral movement, the scapula continues to rotate and begins to elevate. How much does the clavicle rotate posteriorly on a long axis during this stage?

5° to 8°

What is the maximum amount of elevation through abduction at the glenohumeral joint if the clavicle does not rotate and elevate?

120°

In reverse scapulohumeral rhythm, which component of the shoulder complex moves more than the other?

Scapula

What is the normal range of active elevation through forward flexion?

160° to 180°

What should the examiner observe during the last 30° of forward flexion elevation to ensure normal movement of the kinetic chain?

All of the above

Which of the following is considered an open-kinetic-chain activity?

Eating

What is the term used to describe the premature excessive elevation or protraction of the scapula during arm lowering?

Scapular dysrhythmia

What is the range of active elevation through abduction in the shoulder?

170° to 180°

What is the main cause of shoulder pain in individuals who use their shoulder excessively, especially with overhead movement?

Rotator cuff overuse

What is the term used to describe the slouched (rounded shoulder) posture with forward-head posture?

Scapular protraction

Which of the following is a group of counteracting muscles that work together to produce smooth movement and joint control?

Force couples

Which motion of elevation is considered the most natural and functional?

Scaption

What is the exact angle of elevation in scaption determined by?

The contour of the chest wall

Which position of elevation is often less painful than elevation through abduction or forward flexion?

Neutral elevation

Which plane of motion puts less stress on the capsule and surrounding musculature?

Scaption

What is the range of total elevation in scaption?

170°

What is the normal range of active lateral rotation in the shoulder?

80° to 90°

Which of the following is the most common cause of a painful arc in the shoulder?

Subacromial bursitis

During a painful arc in the shoulder, the pain is usually greater when?

Going up (against gravity)

Which of the following tests is a strong indicator of a full-thickness rotator cuff tear?

Drop-arm test

Which joint is primarily affected in the second painful arc in the shoulder?

Acromioclavicular joint

What is the ratio of movement between the humerus and scapula during 180° of abduction?

3:2

What is the main function of the shoulder in the kinetic chain?

To provide mobility

During phase 2 of scapulohumeral movement, how much motion is possible at the acromioclavicular joint during the rotation of the scapula?

20°

What is the term used to describe scapular winging that occurs because of pathology in the glenohumeral joint, altering the normal movement of the scapula?

Dynamic winging

What is the angle of torsion in the humeral head relative to the line joining the epicondyles?

30°

What may a sulcus deformity indicate?

Subacromial impingement

What can cause inflammation of the paratenon in the shoulder?

Impingement syndrome

Which nerve may be injured as it passes through the suprascapular notch, leading to atrophy and paralysis of the supra- and infraspinatus muscles?

Suprascapular nerve

Which of the following is true about the examination of the shoulder?

The examination of the shoulder can be extensive and may include an assessment of the cervical spine.

Which of the following is true about the arm and shoulder in relation to kinetic chains?

The arm can act as an open kinetic chain when the hand is free to move or as a closed kinetic chain when the hand is fixed to an immovable object.

Which of the following is an example of scapular instability with a closed kinetic chain?

The arm is fixed and the rotator cuff muscles work in reverse order.

Which of the following is an example of scapular instability with an open kinetic chain?

The scapula must be stabilized during high-speed movements.

What becomes the stable part and what becomes the mobile part in scapular instability with a closed kinetic chain?

The insertion of the muscles into the humerus becomes the stable part, whereas the scapula becomes the mobile part.

What becomes the base or origin of the muscles and what becomes more mobile in scapular instability with an open kinetic chain?

The scapula becomes the base or origin of the muscles, whereas the insertion into the humerus becomes more mobile.

Which of the following is a test that can be used to assess the glenohumeral joint's true medial and lateral rotation?

Abduction test

What does the presence of crepitus during rotation in 90° of abduction indicate?

Abrasion of torn tendon margins against the coracoacromial arch

What is GIRD?

The difference in medial rotation between the patient's two shoulders

What is the normal range for GIRD?

Within 20°

What does a GIRD/GERG ratio greater than 1 indicate?

The patient will probably develop shoulder problems

Which of the following movements involves the patient squeezing the shoulder blades together?

Scapular retraction

Which muscle is responsible for scapular winging when weak or paralyzed?

Serratus anterior muscle

What may cause a clicking or snapping near the inferior angle or supramedial corner of the scapula?

Scapular protraction

Which joint may be affected if a patient experiences pain in the sternoclavicular joint during scapular protraction?

Sternoclavicular joint

Which movement involves the patient trying to bring the shoulders together anteriorly?

Shoulder adduction

Which muscle is responsible for scapular winging during abduction and forward flexion?

Serratus anterior

What is the main function of the subscapularis muscle?

Medial rotation of the humerus

Which nerve is responsible for paralysis of the deltoid and teres minor muscles, affecting abduction and lateral rotation of the shoulder?

Axillary nerve

What is the term used to describe scapular winging that occurs due to injury to the long thoracic nerve?

Static winging

What is the main ligament maintaining the integrity of the acromioclavicular joint?

Acromioclavicular ligament

Which of the following is true about humeral retroversion (HR)?

HR decreases with high-stress overload activities

What is the purpose of the dynamic rotary stability test (DRST)?

To assess the ability of the rotator cuff to maintain arthrokinematic control

What is the purpose of the dynamic relocation test (DRT)?

To test the ability of the rotator cuff to stabilize the humeral head

What is the normal range of active extension in the shoulder?

50° to 60°

What is the normal range of adduction in the shoulder if the arm is brought in front of the body?

50° to 75°

During a shoulder examination, if the range of motion (ROM) is not full during active movements, what should the examiner do to determine the end feel?

Perform all passive movements of the shoulder

In addition to the four shoulder joints, what other structures should be evaluated during a passive examination of the shoulder?

Ribs and spine

What should the examiner do if there is a restriction in rib and spinal movement during a passive examination of the shoulder?

Note the restriction and proceed with the examination

What is the purpose of performing passive movements of the shoulder during an examination?

To determine the end feel

If the examiner is unable to test the end feel during active movements, what type of movements should be performed to determine the end feel?

Passive movements of the shoulder

Which of the following muscles may be found to be tight in a patient with anterior shoulder instability?

Subscapularis, pectoralis minor and major, latissimus dorsi

Which of the following is a possible cause of dynamic scapular winging with reverse scapulohumeral rhythm?

Weak lower trapezius and serratus anterior muscles

What is the recommended range of repetitions for repetitive movements in the assessment of shoulder pain?

10 to 20 repetitions

What is the primary function of the scapulothoracic joint?

To allow for movement of the scapula on the thorax

What is the main advantage of elevating the arm with the humerus in medial rotation during assessment?

Minimizes excursion of the bicipital groove along the biceps tendon

Which of the following is true about humeral retroversion (HR)?

HR decreases with age.

What may excessive lateral rotation in the shoulder lead to?

Posterior impingement.

Which test assesses the rotator cuff's ability to maintain the humeral head in the glenoid through the arc of rotation?

Dynamic rotary stability test (DRST).

What is the normal range of active extension in the shoulder?

50° to 60°.

What is the normal range of horizontal adduction in the shoulder?

50° to 75°.

Which muscle is weak in a patient with anterior humeral translation?

Subscapularis

What may cause excessive scapular retraction during lateral rotation?

Tight anterior capsule

What muscle is responsible for winging of the scapula when weak?

Serratus anterior

What nerve is injured if there is winging of the scapula or scapular tilt?

Spinal accessory nerve

What muscles are affected by damage to the radial nerve?

All extensor muscles of the upper limb

Which position should the rotation testing be done in to get a clearer indication of the glenohumeral joint's true medial and lateral rotation?

90° abduction

What does crepitus during rotation testing in 90° of abduction indicate?

Abrasion of torn tendon margins against the coracoacromial arch

What is GIRD?

Difference in medial rotation between the patient's two shoulders

What is the normal difference in medial rotation between the patient's two shoulders?

20°

What does a GIRD/GERG ratio greater than 1 indicate?

Impending shoulder problems

Which muscles may be found to be tight in a patient with anterior shoulder instability?

Subscapularis, pectoralis minor and major, latissimus dorsi

What is the primary cause of Type II scapular dysfunction?

Weak lower trapezius and serratus anterior muscles

What may a flattening of the deltoid muscle area indicate?

Weak serratus anterior muscle

What is the resting position of the scapulothoracic joint?

Depression and downward rotation

What movement may cause pain in an unstable and painful shoulder when the hand is placed behind the head with the elbow backward?

Horizontal adduction

Which of the following movements involves the patient squeezing the shoulder blades together?

Scapular retraction

Which muscle is responsible for scapular stabilization during shoulder movements?

Serratus anterior

Which movement pattern of scapular dysfunction is characterized by the whole medial border of the scapula being prominent and lifting away from the posterior chest wall both statically and dynamically?

Scapular winging

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Inferior glenohumeral ligament

Which movement involves the patient trying to bring the shoulders together anteriorly, causing the scapula to move away from midline with the inferior angle of the scapula commonly moving laterally more than the superior angle?

Scapular protraction

Which of the following is true about passive movements in shoulder examination?

Passive movements are used to test the end feel of the shoulder joints.

What should be noted if there is a restriction in rib and spinal movement during passive shoulder examination?

The restriction in rib and spinal movement can restrict shoulder movement.

When should the examiner perform passive movements of the shoulder in shoulder examination?

When the active range of motion is not full and the end feel cannot be tested.

What is the purpose of performing passive movements in shoulder examination?

To determine the end feel of the shoulder joints.

Which structures should be examined during passive shoulder examination?

The mobility of the four shoulder joints, ribs, and spine.

Which movement of the humerus occurs automatically or subconsciously with movement?

Medial rotation

At what angle of abduction does the shoulder exhibit 90° of medial rotation?

120°

What is the purpose of the quadrant test?

All of the above

What is the position called when the shoulder no longer abducts due to the catching of the greater tuberosity in the subacromial space?

Locked quadrant position

What is the order of restriction in the capsular pattern of the shoulder?

Lateral rotation, abduction, medial rotation

What indicates a noncapsular pattern of shoulder movement limitation?

Finding of limitation in the opposite order

What does scapular protraction, winging, or tilting during isometric testing indicate?

Weakness of the scapular control muscles

Which of the following is NOT a criteria for considering treatment intervention in the ROM of the shoulder?

Anterior hyperlaxity with lateral rotation greater than 85°

What is the definition of inferior hyperlaxity?

Positive hyperabduction test with a side-to-side difference greater than 20°

What is the difference between the end feel of capsular tightness and muscle tightness?

Capsular tightness has a harder, more elastic feel to it

How can one differentiate between muscular and capsular tightness?

Ask the patient to contract the muscles acting in the opposite direction

What can a tight posterior capsule cause?

Increased scapular protraction and depression

Which directions of movement are primarily limited in a frozen shoulder (adhesive capsulitis)?

Lateral rotation, abduction, and medial rotation

What is the purpose of the dynamic relocation test (DRT)?

To assess scapular dyskinesia

Which of the following is true about frozen shoulder?

It can be divided into primary and secondary types

How is posterior capsular tightness measured in shoulder examination?

By measuring the angle relative to the vertical position

How is passive medial rotation measured in shoulder examination?

With the subject in supine and the humerus in 90° of abduction

What is the recommended position for measuring rotation in shoulder examination?

Side lying with the humerus in 90° of abduction

What is the recommended method for measuring lateral rotation in shoulder examination?

Passive rotation with the elbow on the table

What may excessive lateral rotation in the shoulder lead to?

Limited supination

What is the normal range of abduction in the glenohumeral joint alone?

Up to 120°

During the active movements, the examiner should have noted which movements caused discomfort or pain so that this information can be correlated with that obtained from resisted isometric movements. What is the purpose of correlating the information obtained from active movements with that obtained from resisted isometric movements?

To determine the specific contractile tissue that has been injured

Which muscles should receive particular attention during the examination of the shoulder?

Rotator cuff muscles

What is the initial position for resisted isometric tests of the muscles of the shoulder?

Arm at the side with the elbow flexed to 90°

What is the region of hypovascularity of the long head of biceps?

1.2 to 3 cm (0.5 to 1.2 inches) from its origin at the coracoid process

Which muscle is suspected to be the problem if the patient experiences pain primarily on medial rotation but also on abduction and adduction?

Subscapularis muscle

Which muscles act over both the elbow and the shoulder?

Biceps and triceps

What is the term used to describe a third-degree strain (rupture) of the long head of biceps tendon at the shoulder?

Popeye sign

What are special tests used for in shoulder examinations?

To confirm findings

Why are special tests not necessarily definitive or discriminatory in diagnosing shoulder injuries?

Because too many pain-generating structures in the shoulder cause the same painful symptoms

During the quadrant test, at approximately what angle of abduction does the humerus move forward?

120°

What is the position called when the shoulder no longer abducts at about 120° of abduction due to the catching of the greater tuberosity in the subacromial space?

Locked quadrant position

Which movement shows the greatest restriction in the capsular pattern of the shoulder?

Lateral rotation

What indicates weakness of the scapular control muscles during resisted isometric movements?

Scapular protraction

At what angle of adduction does the quadrant position occur during shoulder abduction/adduction?

120°

Which movement normally has a tissue-stretch end feel in the capsular pattern of the shoulder?

Lateral rotation

What should the examiner be aware of when performing the quadrant test and the locked quadrant test?

They may cause pain in the glenohumeral joint

Which of the following is true about glenohumeral lateral rotation?

All of the above

What is the definition of anterior hyperlaxity?

Lateral rotation greater than 85° with the arm at the side

How can capsular tightness be differentiated from muscle tightness?

Capsular tightness has a harder, more elastic feel to it and usually occurs earlier in the ROM

When should capsular tightness be measured?

If the range increases when the patient contracts the muscles acting in the opposite direction

What can a tight posterior capsule cause?

Increased scapular protraction and depression

What movements does a frozen shoulder primarily limit?

Lateral rotation, abduction, and medial rotation

What does a reverse scapulohumeral rhythm indicate?

A frozen shoulder (i.e., adhesive capsulitis)

Which muscles should receive particular attention during a shoulder examination?

Supraspinatus, subscapularis, and trapezius

What is the region of hypovascularity of the long head of biceps from its origin at the coracoid process?

1.2 to 3 cm

What percentage of all biceps ruptures occur to the long head?

96%

Which muscle is primarily responsible for medial rotation of the shoulder?

Subscapularis

What is the term used to describe abnormal positions of the scapula such as tilting, winging, or dysrhythmia?

Scapular dyskinesis

What ligament limits lateral rotation between 45° and 90° of abduction?

Glenohumeral ligament

What is the angle between the humeral neck and shaft in adults?

90°

What movement may cause pain in an unstable and painful shoulder when the hand is placed behind the head with the elbow backward?

Medial rotation

What is the normal range of active elevation through forward flexion?

0° to 135°

Which of the following is true about frozen shoulder?

Frozen shoulder can be primary or secondary.

How is posterior capsular tightness measured in shoulder examination?

The patient is placed in supine lying with the arm forward flexed to 90° and the elbow flexed to 90°.

How is passive medial rotation of the humerus measured in shoulder examination?

The patient is in supine lying with the arm by the side and the elbow flexed to 90°.

How is passive lateral rotation of the humerus measured in shoulder examination?

The patient is in supine lying with the arm by the side and the elbow flexed to 90°.

What is the recommended position for measuring rotation in shoulder examination?

Side lying

What is the recommended method for measuring lateral rotation in shoulder examination?

The "elbow on the table" (EOT) method

What is the recommended position for measuring lateral rotation in shoulder examination?

Supine lying

Which of the following factors may contribute to abnormal motion within the shoulder complex?

Tight posterior capsule

What is the term used to describe abnormal motion within the shoulder complex?

Instability

Which system did Kuhn et al. advocate for diagnosing glenohumeral instability?

FEDS System

What is the primary cause of impingement in older patients?

Degenerative changes to the rotator cuff

What is the recommended position for measuring rotation in shoulder examination?

Sitting

What does the presence of crepitus during rotation in 90° of abduction indicate?

Rotator cuff tear

Which test is similar to the apprehension test but is done with the arm at 45° abduction instead of 90° and the elbow at 90° and then laterally rotated?

Castagna test

What does a positive relocation test indicate?

All of the above

What does a positive crank test with pain predominating during the test and disappearing with the relocation test indicate?

Primary impingement

What is the purpose of the bony apprehension test?

To look for bony defects

What does a positive supine apprehension test indicate?

Glenohumeral instability

What should be done before releasing the posterior stress in the relocation test?

Release lateral rotation

Which of the following tests is used to assess for a bony defect contributing to anterior instability in the shoulder?

Load and Shift Test

What is the recommended position for the patient during the Load and Shift Test?

Sitting with no back support

What is the purpose of the 'load' portion of the Load and Shift Test?

To assess the amount of translation

What is considered normal anterior translation of the humeral head during the Load and Shift Test?

Less than 25% of the humeral head diameter

Which of the following is true about the amount of translation during the Load and Shift Test?

Anterior and posterior translation are virtually equal

What is the primary purpose of comparing the affected and normal sides during the Load and Shift Test?

To assess the ease of movement

Which test is a modification of the load and shift test and is used to assess for anterior shoulder instability?

Andrews’ Anterior Instability Test

Which test is used to assess for anterior shoulder instability by comparing the amount of movement available with that of the normal side?

Anterior Drawer Test of the Shoulder

Which test is used to assess for anterior shoulder instability by observing the movement of the finger palpating the anterior humeral head?

Anterior Instability Test (Leffert’s Test)

Which test is primarily designed to check for traumatic instability problems causing gross or anatomical instability of the shoulder?

Apprehension (Crank) Test for Anterior Shoulder Dislocation

What does a positive Apprehension (Crank) Test for Anterior Shoulder Dislocation indicate?

Anterior instability

What does a positive Anterior Instability Test (Leffert’s Test) indicate?

Anterior instability

Which of the following is true about secondary impingement in the shoulder?

It is primarily caused by muscle imbalance and abnormal movement patterns

What is the difference between laxity and instability in the shoulder?

Laxity refers to nonpathological looseness in a joint, while instability refers to the inability to control or stabilize a joint

What is the term used to describe impingement that occurs posteriorly in the shoulder?

Internal impingement

What is the classification of impingement and instability developed by Jobe and colleagues?

Grade I: Pure impingement with no instability, Grade II: Secondary impingement and instability caused by chronic capsular and labral microtrauma, Grade III: Secondary impingement and instability caused by generalized hypermobility or laxity, Grade IV: Primary instability with no impingement

What type of impingement involves contact of the undersurface of the rotator cuff with the posterosuperior glenoid labrum when the arm is abducted to 90° and laterally rotated fully?

Internal impingement

What is the term used to describe chronic overuse damage to the structures of the shoulder in elite swimmers?

Swimmer's shoulder

Which test is recommended for assessing glenohumeral instability and injury to the middle glenohumeral ligament?

Castagna test

What is the position of the arm during the Castagna test?

45° abduction

What does a positive test result indicate in the Castagna test?

Loose anterior capsule and injury to the middle glenohumeral ligament

Which test is recommended for swimmers and is performed at 135° abduction?

Bak test

What is the purpose of the Jobe relocation test?

To assess glenohumeral instability

What does a positive test result indicate in the Jobe relocation test?

Glenohumeral instability, subluxation, dislocation, or impingement

Which of the following factors can contribute to shoulder instability?

All of the above

Which diagnostic system is recommended for diagnosing glenohumeral instability?

FEDS System

What is the primary problem in mechanical impingement in older patients?

Degenerative changes to the rotator cuff

What is the term used to describe altered shoulder mechanics involving a tight posterior capsule, altered arthrokinematics of the glenohumeral joint, and scapular dyskinesia?

Scapular instability

Which diagnostic tool may increase individual confidence to move and adhere to treatment plans for rotator cuff symptoms?

SSMP

Which of the following is NOT a potential cause of abnormal motion and instability at the shoulder complex?

Rotator cuff injury

Which test is a modification of the load and shift test and is used to assess for anterior shoulder instability?

Anterior Instability Test (Leffert’s Test)

What is the primary purpose of the Hawkins and Bokor test?

To differentiate between instability and impingement

What is the main purpose of the apprehension (crank) test for anterior shoulder dislocation?

To check for traumatic instability problems causing gross or anatomical instability of the shoulder

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Superior glenohumeral ligament

At what age may calcium deposits occur?

Adulthood

What is the ratio of movement between the humerus and scapula during 180° of abduction?

2:1

Which of the following is NOT a type of impingement syndrome in the shoulder?

Outlet impingement syndrome

Which grade of impingement and instability in throwing athletes is characterized by primary instability with no impingement?

Grade IV

Which type of impingement is found posteriorly in overhead athletes?

Internal impingement

Which type of instability includes altered glenohumeral arthrokinematics because of the presence of a SLAP lesion, a tight posteroinferior capsule, and often scapular dyskinesia?

Pseudolaxity

Which type of instability includes muscle weakness and unbalanced force couples?

Translational instability

Which ligament limits lateral rotation between 45° and 90° of abduction in the shoulder?

Coracoacromial ligament

Which test is used to check primarily atraumatic instability problems of the glenohumeral joint?

Load and Shift test

What is the most common cause of a painful arc in the shoulder?

Impingement syndrome

What is the normal range of active extension in the shoulder?

0-60 degrees

What is the term used to describe altered shoulder mechanics, commonly involving a tight posterior capsule, altered arthrokinematics of the glenohumeral joint, and scapular dyskinesia?

Shoulder dysfunction

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Superior glenohumeral ligament

What age group is primary impingement usually seen in?

Middle-aged adults

Which of the following is true about primary impingement in the shoulder?

It occurs in older patients

What is the main problem associated with secondary impingement in the shoulder?

Joint laxity

What type of impingement is found posteriorly in overhead athletes?

Internal impingement

Which type of instability is characterized by muscle weakness in the shoulder?

Translational instability

What is the term used to describe altered shoulder mechanics, commonly involving a tight posterior capsule, altered arthrokinematics of the glenohumeral joint, and scapular dyskinesia?

Pseudolaxity

What type of instability is characterized by static restraints being injured or muscles controlling the joint being weak or unbalanced?

Gross or anatomical instability

Which test is recommended for assessing glenohumeral instability in swimmers at the position of the arm at the initiation of the pull-through phase?

Bak test

What does posterosuperior pain during the Castagna test indicate?

Loose anterior capsule

When is the Jobe relocation test considered positive?

If pain decreases during the maneuver

What does the Fowler sign or test, also known as the Jobe relocation test, indicate?

Glenohumeral instability

What does a positive crank test with disappearance of apprehension during the relocation test indicate?

Glenohumeral instability

When is the relocation test positive for posterior internal impingement?

If posterior pain decreases

Which test is used to assess for anterior shoulder instability by comparing the amount of movement available with that of the normal side?

Anterior Drawer Test of the Shoulder

Which test is a modification of the load and shift test and is used to assess for anterior shoulder instability by lifting the humeral head forward?

Andrews’ Anterior Instability Test

Which test is used to assess for anterior shoulder instability by abducting and laterally rotating the arm while palpating for movement of the anterior humeral head?

Anterior Instability Test (Leffert’s Test)

Which test is primarily designed to check for traumatic instability problems causing gross or anatomical instability of the shoulder?

Apprehension (Crank) Test for Anterior Shoulder Dislocation

What does a positive Anterior Drawer Test of the Shoulder indicate?

Anterior instability

What does a positive Apprehension (Crank) Test for Anterior Shoulder Dislocation indicate?

Anterior instability

Which of the following factors can contribute to instability at the shoulder?

All of the above

What is the primary problem in mechanical impingement in older patients?

Degenerative changes to the rotator cuff

Which system was advocated by Kuhn et al. for diagnosing glenohumeral instability?

Frequency, etiology, direction, and severity

What is the primary function of the labrum in the glenohumeral joint?

To increase the surface area of contact between the glenoid and humeral head

Which test is used to assess for anterior shoulder instability by comparing the amount of movement available with that of the normal side?

Load and Shift Test

What does a positive test result indicate in the Shoulder Symptom Modification Procedure (SSMP)?

Rotator cuff symptoms are modifiable

Which test is used if an unreduced anterior shoulder dislocation is suspected?

Dugas' test

Which test is designed to check primarily atraumatic instability problems of the glenohumeral joint?

Load and shift test

What is the normal range of anterior translation of the humeral head during the load and shift test?

Less than 25% of the humeral head diameter

What is the most common cause of a false-negative test in the load and shift test?

Tight posterior capsule

Which ligament prevents medial displacement of the clavicle in the sternoclavicular joint?

Costoclavicular ligament

What is the purpose of the dynamic relocation test (DRT)?

To assess anterior shoulder instability

Which test is used to assess for posterior instability or dislocation of the humerus?

Posterior Drawer Test

What is the primary complaint of patients with inferior instability and multidirectional instability?

Pain

Which test is a modification of the sulcus sign test and is used to assess for abduction inferior stability?

Feagin Test

What is considered normal translation of the humeral head during the posterior drawer test?

Less than 50% of the humeral head diameter

Which movement is the examiner performing during the posterior subluxation test?

Horizontal abduction and lateral rotation

Which test is used to assess for posterior instability and demonstrates significant posterior translation of the humeral head?

Posterior Drawer Test

Which grade of anterior translation is characterized by the humeral head riding up to the glenoid rim and spontaneously reducing?

Grade I

What percentage of humeral head translation is considered normal for posterior translation?

25% to 50%

In which direction would one normally expect greater translation during the load and shift test?

Posterior

At what angle is the patient's arm taken to test anterior translation in the load and shift test?

45° to 60° scaption

What force is applied by the examiner to test anterior translation in the load and shift test?

Anterior or anteroinferior translation force

What should ideally be done to the humerus before starting the load and shift test?

Place it in neutral rotation

What test is recommended for assessing posterior shoulder instability by doing a posterior load and shift test with the arm abducted to 90° and in neutral rotation coupled with a posteriorly directed axial load?

Load and Shift Test

What is the positive finding in the Jerk Test for recurrent posterior instability?

Sudden jerk or clunk as the humeral head slides off the back of the glenoid

What is the Miniaci Test used for?

Assessing posterior shoulder instability

What is the recommended position for the patient during the Norwood Stress Test for Posterior Instability?

Supine

What is the positive finding in the Cofield and Irving version of the Norwood Stress Test for Posterior Instability?

Posterior humeral head subluxation

What is the positive finding in the Posterior Apprehension or Stress Test?

Humeral head slipping posteriorly relative to the glenoid

What is the purpose of the sulcus sign test in shoulder examination?

To assess for inferior shoulder instability

What is the purpose of the hyperabduction test in shoulder examination?

To assess for multidirectional shoulder instability

What is the purpose of the HERI test in shoulder examination?

To assess for anterior shoulder instability

What is the purpose of the knee-shoulder test in shoulder examination?

To assess for multidirectional shoulder instability

What is the purpose of the Rowe test for multidirectional instability in shoulder examination?

To assess for multidirectional shoulder instability

What is the purpose of the hyperextension-internal rotation (HERI) test in shoulder examination?

To assess for anterior shoulder instability

Which movement causes the posterior band of the inferior glenohumeral ligament and the posteroinferior capsule to become increasingly tight, resulting in a decrease in posterior translation?

Medial rotation

Which test for anterior instability involves the patient lying prone while the examiner abducts the patient's arm to 90° and laterally rotates it 90°, and then pushes the humeral head forward?

Protzman Test

Which test for anterior instability involves the examiner palpating the anterior aspect of the head of the humerus with the fingers of one hand deep in the patient's axilla while the fingers of the other hand are placed over the posterior aspect of the humeral head, and then pushing the humeral head anteriorly and inferiorly?

Rowe Test

Which test for posterior instability involves the examiner standing behind the seated patient, rotating the patient's shoulder laterally with the arm at the patient's side, and then repeating the rotation at different angles of abduction?

Rockwood Test

Which test for anterior instability involves the patient lying supine and placing the hand of the affected side behind their head, while the examiner pushes up against the posterior humeral head and extends the arm slightly?

Rowe Test

Which type of impingement is found posteriorly in overhead athletes?

Internal impingement

What is considered grade I in the three-grade system for anterior translation?

0% to 25% of humeral head translation

What is considered grade II in the three-grade system for anterior translation?

25% to 50% of humeral head translation

What is considered grade III in the three-grade system for anterior translation?

75% to 100% of humeral head translation

What is considered normal translation for posterior translation of the humeral head?

25% to 50% of humeral head translation

What is the recommended position for measuring rotation in shoulder examination?

Supine position

How should the examiner hold the patient's arm during the load and shift test for anterior translation?

Near the wrist

Which movement is used to test posterior translation (posterior instability) of the shoulder?

Medial rotation

Which test is used to assess anterior instability of the shoulder while the patient is lying prone?

Protzman Test

Which test is used to assess anterior instability of the shoulder while the patient is sitting?

Rowe Test

Which test is used to assess posterior instability of the shoulder?

Fulcrum Test

Which ligament is primarily involved in limiting anterior translation of the humerus?

Inferior glenohumeral ligament

Which ligament is primarily involved in limiting posterior translation of the humerus?

Inferior glenohumeral ligament

Which test is used to assess for posterior instability or dislocation of the humerus?

Posterior Drawer Test

What is considered a normal translation of the humeral head during the Posterior Drawer Test?

Less than 50% of the humeral head diameter

Which test is used to assess for posterior instability by applying a posteriorly directed force at the patient's elbow while moving the shoulder into horizontal abduction and lateral rotation?

Posterior Subluxation Test

What is a positive result of the Posterior Subluxation Test?

Clunk heard during movement

Which test is a modification of the sulcus sign test and is used to assess for inferior instability?

Feagin Test

What is the primary complaint of patients with inferior instability and multidirectional instability?

Pain

Which test is used to assess posterior shoulder instability by applying a posteriorly directed axial load with the arm abducted to 90° and in neutral rotation?

Load and Shift Test

Which test is performed by extending the patient's arm while maintaining slight abduction, bringing the arm over the top and into the flexed and adducted position, and palpating the posterior aspect of the shoulder for subluxation?

Circumduction Test

Which test involves axially loading the humerus in a proximal direction while moving the arm horizontally across the body, and produces a sudden jerk or clunk if there is recurrent posterior instability?

Jerk Test

Which test is used to assess posterior subluxation by flexing, adducting, and medially rotating the patient's arm while pushing the humerus posteriorly?

Miniaci Test for Posterior Subluxation

Which test involves palpating the posterior humeral head while bringing the patient's arm into horizontal adduction to the forward flexed position, and feeling the humeral head slide posteriorly?

Norwood Stress Test for Posterior Instability

Which test is used to assess posterior instability by elevating the patient's shoulder to 90° while stabilizing the scapula, and palpating the posterior humeral head for sliding posteriorly?

Norwood Stress Test for Posterior Instability

What is the purpose of the Feagin test in shoulder examination?

To assess the inferior glenohumeral ligament

Which test is used to assess the inferior glenohumeral ligament and a possible inferior labral tear?

Gagey Hyperabduction Test

What is the purpose of the HERI Test in shoulder examination?

To assess the superior glenohumeral ligament

What is the purpose of the Knee-Shoulder Test in shoulder examination?

To assess anterior and multidirectional instability

What is the purpose of the Rowe Test for Multidirectional Instability in shoulder examination?

To assess inferior instability

What is the purpose of the Hyperextension-Internal Rotation (HERI) Test in shoulder examination?

To assess the inferior glenohumeral ligament and inferior capsule

Which grade of anterior translation is considered normal when the humeral head translates up to 50% of its diameter and reduces spontaneously?

Grade I

What is the expected amount of posterior translation of the humeral head considered normal?

50% of the diameter of the humeral head

What is the recommended position of the patient during the load and shift test for anterior translation?

Supine

What is the ideal position of the patient's arm during the load and shift test for anterior translation?

45° to 60° scaption

Which direction of translation is normally expected to be greater when performing the load and shift test for anterior translation?

Posterior translation

What force is applied by the examiner to test anterior translation during the load and shift test?

Anterior or anteroinferior translation force

Which test is used to assess for posterior instability or dislocation of the humerus?

Posterior Drawer Test

What is the normal range of posterior translation of the humeral head during the posterior drawer test?

Less than 50% of the humeral head diameter

Which test is similar to the Norwood test but without the horizontal adduction?

Feagin Test

Which test is used to assess for posterior instability and demonstrates significant posterior translation of the humeral head?

Apprehension Test

Which test is a modification of the sulcus sign test and is used to assess for abduction inferior stability?

ABIS Test

What does a positive test result in the Push-Pull Test indicate?

Posterior instability

Which test is used to assess the inferior glenohumeral ligament and a possible inferior labral tear?

Hyperabduction test

What is the purpose of the Hyperextension-Internal Rotation (HERI) test?

To assess the inferior glenohumeral ligament and inferior capsule

Which test is used to evaluate for anterior and multidirectional instability?

Rowe test

What is the recommended position for the patient during the Jobe relocation test?

Seated

Which test involves the examiner pushing the humeral head anteriorly and inferiorly while the patient's arm is extended 20° to 30° from the vertical position?

Rowe test

What is the purpose of the knee-shoulder test?

To assess for shoulder dislocation

What is the best test for assessing posterior humeral avulsion of the glenohumeral ligament (HAGL) lesion?

Posterior load and shift test

Which test is performed by extending the patient's arm while maintaining slight abduction, bringing the arm over the top and into the flexed and adducted position, and palpating the posterior aspect of the shoulder for subluxation?

Circumduction test

What is a positive test result in the jerk test (Jahnke test) indicative of?

Recurrent posterior instability

Which test is used to assess posterior subluxation of the humerus and involves flexing, adducting, and medially rotating the arm while pushing the humerus posteriorly?

Miniaci test

What is the recommended position for measuring lateral rotation in shoulder examination?

90° abduction and neutral rotation

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Glenohumeral ligament

Which of the following tests is used to assess for anterior shoulder instability by pushing the humeral head forward while the patient lies supine with the hand of the affected side behind their head?

Rowe Test

Which of the following tests is used to assess for posterior shoulder instability by applying a posterior translation force to the humerus while the arm is in scaption with lateral rotation?

Prone Anterior Instability Test

Which ligament is primarily involved in limiting anterior translation of the humerus during shoulder examination?

Inferior Glenohumeral Ligament

Which of the following statements about the anterior translation of the humerus during shoulder examination is NOT true?

Lateral rotation of the humerus increases the involvement of the anterior band of the inferior glenohumeral ligament.

Which of the following statements about the posterior translation of the humerus during shoulder examination is NOT true?

Posterior translation decreases as medial rotation of the humerus increases.

Which of the following is NOT a test used to assess for anterior shoulder instability?

Rockwood Test

Which position is the patient placed in for the Speed test?

Sitting position

What is the purpose of the Biceps Load Test (Kim Test II)?

To check the integrity of the superior labrum

What is the recommended position for the patient during the Clunk Test?

Supine position

What is the primary cause of impingement in older patients?

Rotator cuff degeneration

What is the recommended arm position for the Anterior Slide Test?

90° abduction and lateral rotation

What is the purpose of the modified test for labral abnormalities?

To standardize the test procedure

Which position is the patient in during the Rowe test for multidirectional instability?

Standing forward flexed at the waist

Which part of the humeral head is palpated during the Rowe test for anterior instability?

Anterior aspect

How is the humeral head pushed during the Rowe test for posterior instability?

With the index and middle fingers

What is the purpose of the Sulcus Sign test?

To test for inferior instability

What does a positive Sulcus Sign indicate?

Inferior instability

How is the Sulcus Sign graded?

By measuring from the inferior margin of the acromion to the humeral head

Which position is recommended for testing for inferior instability in the shoulder?

20° to 50° of abduction with neutral rotation

Which of the following tests is NOT recommended for assessing anterior shoulder impingement?

Drop-arm test

What is the purpose of the Hawkins-Kennedy Impingement Test?

To assess for supraspinatus paratenonitis/tendinosis

What is the Yocum test a modification of?

Hawkins-Kennedy Impingement Test

In which position is the anterior capsule tested to stress it during shoulder examination?

30° to 40° abduction and 0° to 10° flexion

What does a positive test in the Impingement Test indicate?

Grade II or III shoulder lesion

Which test is used to assess for impingement and rotator cuff pathology?

Active Compression Test of O'Brien

Which type of labral tear involves a tear in the superior labrum and instability of the labral-biceps complex?

Type II

Which direction does the labrum detach in a reverse Bankart lesion?

6 o’clock to 9 o’clock

What is the primary cause of a SLAP lesion in overhead athletes?

Deceleration when throwing

Which test is NOT considered accurate for diagnosing a SLAP lesion?

Quadrant Test

Why are tests for labral lesions often not definitive?

All of the above

Which test is used to differentiate between an outlet (subacromial) impingement and an intra-articular (nonoutlet) problem?

Neer Impingement Test

Which test is considered positive in a patient who has a positive impingement test if the patient has good strength in lateral rotation but not medial rotation?

Internal (Medial) Rotation Resistance Strength Test

Which test is used to test the posterior capsule by placing the humerus in 60° to 70° of abduction and 20° to 30° of flexion followed by passive medial rotation?

Posterior Internal Impingement Test

Which test involves pushing the head of the humerus inferiorly as the arm is abducted or laterally rotated to assess for mechanical impingement under the acromion?

Reverse Impingement Sign

Which test is used to assess for impingement by passively and forcibly fully elevating the patient's arm in the scapular plane with the arm medially rotated by the examiner?

Neer Impingement Test

Which test is used to assess for impingement by passively abducting the shoulder to 90° to 110°, with 15° to 20° extension and maximum lateral rotation?

Posterior Internal Impingement Test

Which position is the patient placed in for the anterior slide test?

Sitting position

What is the purpose of the biceps load test (Kim Test II)?

To check the integrity of the superior labrum

What is the recommended position for the patient during the clunk test?

Supine position

What does a positive test in the anterior slide test indicate?

Labral tear

What is the primary cause of impingement in older patients?

Rotator cuff pathology

What is the position called when the shoulder no longer abducts at about 120° of abduction due to the catching of the greater tuberosity in the subacromial space?

Impingement position

Which test is recommended for swimmers and is performed at 135° abduction?

Yocum test

What is the purpose of comparing one side of the body with the other during an assessment?

To evaluate the range of motion

What ligament forms an arch over the humeral head, acting as a block to superior translation?

Coracoacromial ligament

What is the most common congenital deformity of the shoulder complex?

Scapular winging

Which muscle is responsible for winging of the scapula during abduction and forward flexion?

Serratus anterior

What does a GIRD/GERG ratio greater than 1 indicate?

Glenohumeral laxity

Which test is used to assess anterior instability in the shoulder?

Sulcus Sign Test

What is the purpose of the Sulcus Sign Test?

To assess glenohumeral laxity

How is the Rowe Test for Multidirectional Instability performed?

The patient stands forward flexed at the waist with the arms relaxed and pointing to the floor

What does a positive Sulcus Sign indicate?

Inferior instability

How is the Sulcus Sign graded?

By measuring from the inferior margin of the acromion to the humeral head

What is the significance of a bilateral Sulcus Sign?

It is not clinically significant

What is the purpose of the Internal (Medial) Rotation Resistance Strength Test (IRRST)?

To differentiate between outlet and intra-articular impingement

What is the Neer Impingement Test used to assess?

External anterior impingement

What is the purpose of the Modified Neer Test?

To assess internal impingement

What does the Posterior Internal Impingement Test primarily assess?

Internal impingement

What does the Reverse Impingement Sign (Impingement Relief Test) assess?

External anterior impingement

What is the purpose of the Supine Impingement Test?

To assess external anterior impingement

What is the purpose of the Active Compression Test of O'Brien?

To detect SLAP (type II) or superior labral lesions

Which structures are commonly injured in a Bankart lesion?

Anteroinferior labrum and inferior glenohumeral ligament

What is the most common type of SLAP lesion described by Snyder and colleagues?

Type II: Small tear in the superior labrum; instability of the labral-biceps complex

What is the mechanism that can result in a posterior type II SLAP lesion in overhead athletes?

Increased lateral rotation, decreased medial rotation, and a tight posterior capsule

Why is it difficult to accurately diagnose labral tears using only special tests?

All of the above

What is the purpose of the examiner laterally rotating the patient's arm and adducting it into further elevation with the supinated arm against the patient's ear during the impingement test?

To assess for a significant increase in pain with lateral rotation

Which structure is commonly injured in throwing athletes and plays a key role in glenohumeral stability?

Labrum

What type of labral tear occurs when the anteroinferior labrum is torn?

Bankart lesion

Which type of SLAP lesion involves a tear in the superior labrum and instability of the labral-biceps complex?

Type II

What mechanism can result in a posterior type II SLAP lesion in overhead athletes?

Tight posterior capsule

Why is it difficult to accurately diagnose a SLAP lesion using special tests?

There is no specific pain pattern associated with SLAP lesions

What is the Active Compression Test of O'Brien used to detect?

Labral tears

Which position is the patient placed in for the Rowe Test for Multidirectional Instability?

Standing forward flexed at the waist

What is the purpose of the Sulcus Sign test?

To test for inferior instability

How is the Sulcus Sign test performed?

The examiner pulls the arm distally while the patient stands with the arm by the side and shoulder muscles relaxed

What does a positive Sulcus Sign indicate?

Inferior instability

How is the sulcus sign graded?

By measuring from the inferior margin of the acromion to the humeral head

What is the significance of a bilateral sulcus sign?

It is not clinically significant

What is the purpose of the Neer Impingement Test?

To assess for impingement and rotator cuff pathology

What is the purpose of the Internal (Medial) Rotation Resistance Strength Test (IRRST)?

To assess for internal impingement

What is the purpose of the Modified Neer Test?

To differentiate between outlet and intra-articular impingement

What is the purpose of the Posterior Internal Impingement Test?

To assess for posterior internal impingement

What is the purpose of the Reverse Impingement Sign (Impingement Relief Test)?

To assess for mechanical impingement under the acromion

What is the purpose of the Supine Impingement Test?

To assess for impingement and rotator cuff pathology

Which test is used to assess for inferior instability in the shoulder?

Sulcus Sign Test

Which test is used to assess for anterior shoulder impingement?

Hawkins-Kennedy Impingement Test

Which test is a modification of the Hawkins-Kennedy test and involves horizontally adducting the arm across the body?

Coracoid Impingement Sign

Which test is used to assess for secondary impingement of the rotator cuff?

Impingement Test

Which test is used to assess for anterior capsule tightness in the shoulder?

Branch Test

Which test is used to assess for rotator cuff tears?

Painful Arc Sign

Which position is the patient placed in during the anterior slide test?

Sitting with the hands on the waist

What is the purpose of the biceps load test (Kim Test II)?

To check the integrity of the superior labrum

What is the starting position for the modified anterior slide test?

Forward flex both arms to 90° with the thumbs facing the floor

What is the recommended modification for clearer results in the anterior slide test?

Apply a uniform downward force to both arms at the same time

Which joint is "locked and loaded" in the modified anterior slide test?

Acromioclavicular joint

What is the purpose of the clunk test?

To assess for a tear of the labrum

Which position is the patient in for the SLAP Prehension Test?

Sitting

What is the position of the arm for the SLAP Prehension Test?

Abducted to 90° with the elbow extended

What is the position of the forearm for the SLAP Prehension Test?

Pronated (thumb down and shoulder laterally rotated)

What is the position of the forearm for the Supine Flexion Resistance Test?

Supinated (thumb up and shoulder medially rotated)

What movement is the patient asked to perform in the Supine Flexion Resistance Test?

Forward flexion of the arm

What is the position of the arm for the Throwing Test?

Abducted to 90° with the elbow flexed

Which test is primarily designed for young, active patients and involves performing push-up motions for 15 seconds?

Wall Push-up Test

Which test is used to determine disability associated with injury to the acromioclavicular joint?

Acromioclavicular Shear Test

Which test involves the examiner cupping their hands over the deltoid muscle and squeezing the heels of the hands together?

Acromioclavicular Shear Test

Which test is used to evaluate glenohumeral ligaments and capsule when the arm is by the side?

Crank Test

Which test involves the examiner applying pressure to the acromion with the thumb while applying an inferior directed counterforce to the clavicle with the fingers?

Paxinos Sign

Which test is used to test the integrity of the conoid and trapezoid portions of the coracoclavicular ligament?

Coracoclavicular Ligament Test

Which movement pattern is used to test for a SLAP lesion in the shoulder?

Supination of the forearm

Which test is performed with the patient lying supine with both arms fully elevated over the head and the palms facing the ceiling?

Supine Flexion Resistance Test

Which test is performed with the patient standing with the test arm in 90° abduction, the elbow flexed to 90°, and the shoulder in maximum lateral rotation?

Throwing Test

Which test is designed to test dynamic control of the scapula during medial rotation of the glenohumeral joint?

Kinetic Medial Rotation Test

Which test determines the stability of the scapula during glenohumeral movements?

Lateral Scapular Slide Test

What is the primary role of the scapula during shoulder movements?

To provide stability to the glenohumeral joint

Which ligament is being tested at 45° to 60° abduction of the shoulder?

Inferior glenohumeral ligament (anterior band)

What is the purpose of the Low Flexion Test?

To test the posterior glenohumeral joint capsule

Which ligament is being tested in the Posteroinferior Glenohumeral Ligament Test?

Posterior portion of the inferior glenohumeral ligament

What does the Abdominal Compression Test check?

Subscapularis muscle

What is the purpose of the Abrasion Sign test?

To test the rotator cuff tendons

Is there a test or series of tests that can reliably isolate the problem muscle or tendon when examining for rotator cuff tears and subacromial tissues?

No

Which test evaluates scapular and acromial involvement in patients with impingement symptoms?

Scapular Assistance Test (SAT)

Which test is used to assess scapular dyskinesia by observing abnormal movement in the scapula during elevation?

Scapular Dyskinesia Test

Which test is used to assess scapular retraction by having the patient actively retract the scapulae together as hard as possible?

Scapular Isometric Pinch or Squeeze Test

Which test is used to stabilize the clavicle and scapula and to hold the scapula retracted, providing a firm stable base for the rotator cuff muscles?

Scapular Retraction Test (SRT)

Which joint should the examiner primarily watch for movement during the eccentric hold test?

Glenohumeral joint

Which joint should the examiner primarily watch for winging during the Scapular Assistance Test (SAT)?

Scapulothoracic joint

Which movement is used to test for a SLAP lesion in the shoulder?

Adduction

What is the position of the arm during the Supine Flexion Resistance Test?

90° abduction

Which phase of pitching does the Throwing Test simulate?

Acceleration phase

What is the position of the forearm during the SLAP Prehension Test?

Pronated

Where is pain elicited in a positive Supine Flexion Resistance Test?

Bicipital groove

What is the position of the shoulder during the Throwing Test?

90° abduction

Which test is used to assess dynamic control of the scapula during medial rotation of the glenohumeral joint?

Kinetic Medial Rotation Test

Which test determines the stability of the scapula during glenohumeral movements?

Lateral Scapular Slide Test

Which test is used to assess for anterior shoulder instability by lifting the humeral head forward?

Supine Flexion Resistance Test

Which test is used to assess for inferior instability in the shoulder?

Throwing Test

Which test is a modification of the sulcus sign test and is used to assess for inferior instability?

Lateral Scapular Slide Test

Which test is NOT considered accurate for diagnosing a SLAP lesion?

Kinetic Medial Rotation Test

Which of the following tests is designed primarily for young, active patients?

Wall Push-up Test

Which of the following tests is used to determine disability associated with injury to the acromioclavicular joint?

Acromioclavicular Crossover Test

Which of the following tests is used to test the integrity of the conoid portion of the coracoclavicular ligament?

Coracoclavicular Ligament Test

Which of the following tests is used to evaluate the different glenohumeral ligaments?

Crank Test

Which of the following tests is used to test for acromioclavicular joint pathology?

Acromioclavicular Shear Test

Which of the following tests is used to test for glenohumeral arthritis?

Ellman’s Compression Rotation Test

Which ligaments are being tested at 45° to 60° abduction of the shoulder?

Middle glenohumeral ligament, coracohumeral ligament, inferior glenohumeral ligament (anterior band), and anterior capsule

What ligaments and capsule are being tested over 90° abduction of the shoulder?

Inferior glenohumeral ligament and anterior capsule

What is the purpose of the Low Flexion Test?

To strain the posterior glenohumeral joint capsule

Which ligament is being tested in the Posteroinferior Glenohumeral Ligament Test?

Posterior portion of the inferior glenohumeral ligament

What is the recommended position for the patient during the Abdominal Compression Test?

Standing

What muscle does the Abdominal Compression Test primarily assess?

Subscapularis muscle

Which test evaluates scapular and acromial involvement in patients with impingement symptoms?

Scapular Assistance Test (SAT)

Which test is used to assess scapular and humeral stability by performing an eccentric movement at the shoulder by pushing the arm forward?

Scapular Dyskinesia Test

Which test evaluates scapular dyskinesia by observing the movement of the scapula during elevation through abduction and forward flexion?

Scapular Dyskinesia Test

Which test assesses scapular stability by actively retracting the scapulae together as hard as possible and holding the position?

Scapular Isometric Pinch or Squeeze Test

Which test stabilizes the clavicle and scapula, and holds the scapula retracted while the patient actively abducts or forward flexes the arm?

Scapular Assistance Test (SAT)

Which test provides a firm stable base for the rotator cuff muscles and may also improve rotator cuff strength?

Scapular Retraction Test (SRT)

Which ligament is primarily involved in limiting anterior translation of the humerus?

Inferior glenohumeral ligament (anterior band)

What is the primary role of the middle glenohumeral ligament?

Limiting posterior translation of the humerus

What is the purpose of the Sulcus Sign test?

To assess for inferior instability

What does the Posterior Internal Impingement Test primarily assess?

Posterior instability

What is the normal range of abduction in the glenohumeral joint alone?

60° to 90°

Which test evaluates scapular and acromial involvement in patients with impingement symptoms?

Low Flexion Test

Which test is used to assess scapular and humeral stability by performing an eccentric movement at the shoulder by pushing the arm forward?

Wall Push-up Test

Which ligament limits lateral rotation between 45° and 90° of abduction in the shoulder?

Trapezoid Ligament

What type of impingement involves contact of the undersurface of the rotator cuff with the posterosuperior glenoid labrum when the arm is abducted to 90° and laterally rotated fully?

Internal impingement

What age group is secondary impingement due to instability caused by weakness in the scapular or humeral control muscles more common in?

Adolescents

What is the purpose of the quadrant test?

To assess for glenohumeral arthritis

What may a step deformity indicate?

Glenohumeral instability

Which test is used to assess for a SLAP lesion by asking the patient to perform a forward flexion movement of the arm while the examiner resists the movement?

Supine Flexion Resistance Test

Which test is used to assess for a SLAP lesion by asking the patient to simulate a throwing motion while the examiner provides isometric resistance to the shoulder?

Throwing Test

Which test is used to test dynamic control of the scapula during medial rotation of the glenohumeral joint?

Kinetic Medial Rotation Test

Which test is used to determine the stability of the scapula during glenohumeral movements?

Lateral Scapular Slide Test

Which test is used to assess the scapula's ability to dynamically stabilize during movement by applying resistance to the arm at different positions?

Scapular Load Test

Which test has been found to have poor reliability for differentiating normal and pathological shoulders?

Lateral Scapular Slide Test

Which test is used to assess for a SLAP lesion by asking the patient to adduct the arm horizontally?

SLAP Prehension Test

Which test is considered positive for a SLAP lesion if pain is elicited deep inside the shoulder or at the dorsal aspect along the joint line?

Supine Flexion Resistance Test

Which test is used to evaluate glenohumeral ligaments and capsule when the arm is elevated over the head with the palms facing the ceiling?

Supine Flexion Resistance Test

Which test involves the patient standing with the test arm in 90° abduction, the elbow flexed to 90°, and the shoulder in maximum lateral rotation, mimicking the late cocking phase of pitching?

Throwing Test

Which test is used to assess scapular dyskinesia by observing abnormal movement in the scapula during elevation?

Quadrant Test

Which ligament primarily limits inferior translation and helps to limit lateral rotation below 60° of abduction?

Inferior glenohumeral ligament

Which test evaluates scapular and acromial involvement in patients with impingement symptoms?

Scapular Assistance Test (SAT)

What is the purpose of the Scapular Assistance Test (SAT)?

To evaluate scapular and acromial involvement in patients with impingement symptoms

What is the recommended weight for the patient to hold during the Scapular Dyskinesia Test?

1.4 kg (3 lb)

What is the purpose of the Scapular Dyskinesia Test?

To assess for abnormal movement in the scapula

What is the purpose of the Scapular Isometric Pinch or Squeeze Test?

To assess the strength of the scapular retractors

What is the purpose of the Scapular Retraction Test (SRT)?

To provide a firm stable base for the rotator cuff muscles

Which test is used to assess for weakness or paralysis of the serratus anterior muscle?

Punch-Out Test

What does a positive Rhomboid Weakness Test indicate?

Weakness or paralysis of the rhomboids

Which muscle is tested in the Scapula Backward Tipping Test?

Serratus anterior

Which test is used to assess for a tear of the supraspinatus tendon or muscle?

Empty Can Test

What is the starting position for the Serratus Anterior Weakness (Punch-Out) Test?

Standing position

Which muscle is tested in the Teres Minor Test?

Teres Minor

Which of the following tests is used to assess for trapezius muscle or spinal accessory nerve injury?

Active Elevation Lag Test

What is the difference in forward flexion between the two sides called in the Active Elevation Lag Test?

Active elevation lag

Which muscle is assessed in the Bear-Hug Test?

Subscapularis muscle

What is considered a positive test for subscapularis strain in the Bear-Hug Test?

Inability to hold the hand on top of the shoulder

Which nerve is associated with trapezius muscle injury in the Active Elevation Lag Test?

Spinal accessory nerve

What position is the patient in during the Bear-Hug Test?

Standing

Which muscle is tested for weakness or pain during the modified lift-off test?

Subscapularis

Which test is used to assess for bicipital paratenonitis or tendinosis?

Lippman's Test

Which test is used to diagnose a rupture of the long head of the biceps tendon?

Ludington's Test

What does a positive Pectoralis Major Contracture Test indicate?

Tight pectoralis major muscle

What does a positive Pectoralis Minor Tightness test indicate?

Tight pectoralis minor muscle

Which test is used to palpate the anterior margin of the acromion to assess for anterior instability?

Rent Test

Which test is used to assess for an injured subscapularis muscle?

Biceps Entrapment Test

What does a positive test of pain and/or weakness in the Champagne Toast Position indicate?

Injury to the supraspinatus muscle

Which test is used to assess for a tear in the rotator cuff complex?

Drop-Arm (Codman’s) Test

What does a positive test result in the Dropping Sign indicate?

Injury to the infraspinatus muscle

What does a positive test of discomfort or pain in Gilchrest’s Sign indicate?

Bicipital paratenonitis or tendinosis

What is the purpose of Heuter’s Sign?

To assess for bicipital paratenonitis or tendinosis

Which test is used to assess the strength of teres minor?

Hornblower's Sign

Which test is used to assess for an infraspinatus strain?

Infraspinatus Test

Which test is used to assess for rotator cuff pathology?

Lateral Jobe Test

Which test is used to assess for weakness or pain in infraspinatus and teres minor?

Lateral Rotation Lag Sign

Which test is used to assess for tears to the infraspinatus and supraspinatus?

Lateral Rotation Lag Sign

Which test is used to assess for latissimus dorsi weakness?

Latissimus Dorsi Weakness

Which test assesses the trapezius muscle's ability to elevate the arm through forward flexion?

Active Elevation Lag Test

What is the result of injury to the trapezius muscle itself or its nerve supply?

Active Elevation Lag

Which test is used to assess for subscapularis strain?

Bear-Hug Test

What does a positive Bear-Hug Test indicate?

Subscapularis strain

Which test is used to evaluate weakness in the shoulder?

Belly-Off Sign

What is the purpose of the Belly-Off Sign?

To evaluate weakness in the shoulder

Which muscle is primarily responsible for stabilizing the scapula during arm extension?

Rhomboids

What does a positive Ludington's test indicate?

Rotator cuff tear

What is the purpose of the modified lift-off test?

To diagnose a rotator cuff tear

What is the main cause of dynamic scapular winging with reverse scapulohumeral rhythm?

Impingement symptoms

What does a positive Rent test indicate?

Bicipital paratenonitis

What is the purpose of the Pectoralis Major Contracture Test?

To evaluate tightness of the pectoralis major muscle

Which test is used to assess for weakness or paralysis of the deltoid and teres minor muscles?

Teres Minor Test

What is the primary purpose of the Speed's Test?

To assess for weakness of the biceps tendon

Which test is used to assess for a tear of the supraspinatus tendon or muscle?

Supraspinatus Test

What does a positive Punch-Out Test indicate?

Weakness or paralysis of the serratus anterior muscle

What does a positive Scapula Backward Tipping Test indicate?

Tightness of the pectoralis minor muscle

What does a positive Speed's Test indicate?

A SLAP lesion

Which test is used to assess the strength of the teres minor muscle?

Hornblower’s Sign

Which muscle is being tested in the Infraspinatus Test?

Infraspinatus

What is the purpose of the Lateral Jobe Test?

Assess rotator cuff pathology

What does a positive Lateral Rotation Lag Sign indicate?

Weakness or pain in the infraspinatus and teres minor

What is the purpose of the Gerber's Test?

Assess latissimus dorsi weakness

Which muscle is primarily tested in the Lift-Off Sign?

Subscapularis

Which test is used to assess for an injured subscapularis muscle?

Biceps Tightness

What does a positive Biceps Entrapment Test indicate?

Injury to the infraspinatus muscle

What does a positive Biceps Tightness test indicate?

Tightness in the biceps

What does a positive Champagne Toast Position test indicate?

Injury to the supraspinatus muscle

What does a positive Deltoid Extension Lag Sign indicate?

Injury to the deltoid muscle

What does a positive Drop-Arm (Codman’s) Test indicate?

Injury to the rotator cuff complex

Which of the following is true about thoracic outlet syndrome?

A diagnosis of thoracic outlet syndrome is usually made after excluding all other causes.

Which test involves the patient extending their head while the examiner laterally rotates and extends the patient's shoulder?

Adson Maneuver

What is the purpose of the Costoclavicular Syndrome Test?

To test for thoracic outlet syndrome

Which test involves applying downward traction on the test extremity while the patient's neck is hyperextended and the head is rotated to the opposite side?

Halstead Maneuver

What is the purpose of the Roos Test?

To assess for thoracic outlet syndrome

Which test involves the patient standing and abducting the arms to 90°, laterally rotating the shoulder, and flexing the elbows to 90° while opening and closing the hands for 3 minutes?

Roos Test

Which muscle is responsible for the inferior translation and lateral rotation of the inferior angle of the scapula?

Trapezius

What does it indicate if the scapula is elevated more than normal during the Triangle Sign test?

Tight trapezius

What is the end feel and range of motion expected during the Triceps Tightness test?

Muscular tissue stretch, limited elbow extension

What is the purpose of the "Upper-Cut" Test?

To assess biceps injury

Which structure is primarily tested during Yergason's Test?

Biceps tendon

What does a positive Scratch Collapse Test for Axillary Nerve indicate?

Compression neuropathy of the axillary nerve

Which test is primarily designed to check the ability of the coracohumeral ligament and the transverse humeral ligament to hold the biceps tendon in the bicipital groove?

Yergason’s Test

Which test is not as effective as the Speed’s test when testing the biceps tendon?

Yergason’s Test

Which test is used to assess for compression neuropathy of the axillary nerve?

Scratch Collapse Test for Axillary Nerve

Which test is used to assess for compression neuropathy of the long thoracic nerve?

Scratch Collapse Test for Long Thoracic Nerve

Which test is used to tap the area of the brachial plexus above the clavicle to assess for a positive sign indicated by a tingling sensation in one or more of the nerve roots?

Tinel Sign

Which test is the upper limb equivalent of the straight leg raising test of the lower limb and is used when the patient has presented with upper limb radicular signs or peripheral nerve symptoms?

Upper Limb Neurodynamic (Tension) Test (ULNT)

Which muscle is being tested in the patient when they are asked to fully elevate their arms through forward flexion?

Pectoralis Major

What does it indicate if the scapula does not lie flat against the table during the forward flexion test?

All of the above

Which muscle is being tested when the patient is asked to place their hands together over their head and the examiner pushes the elbows forward?

Trapezius

Which part of the trapezius can be tested separately by elevating the shoulder with the arm slightly abducted or to resisted shoulder abduction and head side flexion?

Upper Trapezius

Which muscle is weak if scapular protraction occurs during the test where the patient is in a prone position with the arm abducted to 90° and laterally rotated, and the examiner resists horizontal extension of the arm?

Middle Trapezius

Which muscle is weak if scapular protraction occurs during the test where the patient is in prone lying with arm abducted to 120° and the shoulder laterally rotated, and the examiner applies resistance to diagonal extension?

Lower Trapezius

Which test is used to assess the ability of the coracohumeral ligament and the transverse humeral ligament to hold the biceps tendon in the bicipital groove?

Yergason's Test

Which test is used to assess for compression neuropathy of the axillary nerve?

Scratch Collapse Test for Axillary Nerve

Which test is used to assess for compression neuropathy of the long thoracic nerve?

Scratch Collapse Test for Long Thoracic Nerve

Which test is used to assess for partial rotator cuff tears and/or superior labrum tears?

Whipple Test

Which nerve may be compressed by fibrous bands, scarring after injury, compression in the quadrangular space, or muscle hypertrophy?

Axillary Nerve

Which nerve is associated with allodynia due to compression neuropathy?

Long Thoracic Nerve

What is the Triangle Sign test used to assess?

Trapezius muscle paralysis

What is the purpose of the Triceps Tightness test?

Determine triceps tightness

What does a positive Upper-Cut Test indicate?

Biceps injury

What is the Whipple Test used to assess?

Rotator cuff tears

What does Yergason's Test primarily check the ability of?

Biceps tendon

What does the Scratch Collapse Test for Axillary Nerve assess?

Compression neuropathy of the axillary nerve

Which test is commonly used to assess for thoracic outlet syndrome by locating the radial pulse and having the patient extend the head while the examiner laterally rotates and extends the patient's shoulder?

Adson Maneuver

Which test involves palpating the radial pulse and then drawing the patient's shoulder down and back to assess for thoracic outlet syndrome?

Costoclavicular Syndrome Test

Which test involves applying a downward traction on the test extremity while the patient's neck is hyperextended and the head is rotated to the opposite side to assess for thoracic outlet syndrome?

Halstead Maneuver

Which test involves the patient elevating both arms above the horizontal and rapidly opening and closing the hands 15 times to assess for vascular insufficiency and thoracic outlet syndrome?

Provocative Elevation Test

Which test involves the patient standing and abducting the arms to 90°, laterally rotating the shoulder, and flexing the elbows to 90° while opening and closing the hands slowly for 3 minutes to assess for thoracic outlet syndrome?

Roos Test

Which condition is usually diagnosed as a diagnosis of exclusion, in which all other causes have been eliminated, and may present with neurological and vascular signs?

Thoracic Outlet Syndrome

Which test is primarily designed to check the ability of the coracohumeral ligament and the transverse humeral ligament to hold the biceps tendon in the bicipital groove?

Yergason’s Test

What does a positive Yergason's Test indicate?

Torn transverse humeral ligament

Which test is used to assess compression neuropathy of the axillary nerve?

Scratch Collapse Test for Axillary Nerve

Which nerve may be compressed by fibrous bands, scarring after injury, compression in the quadrangular space, or muscle hypertrophy?

Axillary nerve

What is the purpose of the Tinel Sign test at the shoulder?

Assess compression neuropathy of the long thoracic nerve

What does pain in the cubital fossa during the Upper Limb Neurodynamic (Tension) Test indicate?

Compression of the dura mater in the cervical spine

Which muscle is likely to be tight if the scapula does not lie flat against the examining table during forward flexion of the arms?

Latissimus Dorsi

Which muscle is tested separately by elevating the shoulder with the arm slightly abducted or by resisting shoulder abduction and head side flexion?

Trapezius

Which muscle is tested with the patient in a prone position with the arm abducted to 90° and laterally rotated, by resisting horizontal extension of the arm and watching for retraction of the scapula?

Trapezius

Which muscle is tested with the patient in a prone lying position with the arm abducted to 120° and the shoulder laterally rotated, by applying resistance to diagonal extension and watching for scapular retraction?

Lower Trapezius

Which muscle is likely to be weak if scapular protraction occurs during the test with the patient in prone lying position and the arm abducted to 90° and laterally rotated?

Rhomboids

Which muscle is likely to be weak if scapular protraction occurs during the test with the patient in prone lying position and the arm abducted to 120° and the shoulder laterally rotated?

Lower Trapezius

Which test is primarily designed to check the ability of the coracohumeral ligament and the transverse humeral ligament to hold the biceps tendon in the bicipital groove?

Yergason’s Test

Which test is considered positive for partial rotator cuff tears and/or superior labrum tears?

Whipple Test

Which test is used to test the posterior capsule by placing the humerus in 60° to 70° of abduction and 20° to 30° of flexion followed by passive medial rotation?

Scratch Collapse Test for Axillary Nerve

Which test involves the patient elevating the arms in scaption to 90° with the elbows and wrists extended and the hands in a “fist” position?

Scratch Collapse Test for Axillary Nerve

Which test is not as effective as the Speed’s test when testing the biceps tendon?

Yergason’s Test

Which test is used to test the patient’s isometric lateral rotation bilaterally?

Scratch Collapse Test for Long Thoracic Nerve

Which test is used to assess for arterial relief in patients with symptoms?

Shoulder Girdle Passive Elevation

What is the purpose of the Wright Test or Maneuver?

To detect compression in the costoclavicular space

How is the Allen maneuver performed?

Flexing the patient's elbow to 90° while extending the shoulder horizontally and rotating it laterally

What is the purpose of the costoclavicular syndrome test?

To detect compression in the costoclavicular space

What is the position of the patient during the Wright Test or Maneuver?

Sitting and supine

What is the release phenomenon in relation to the Shoulder Girdle Passive Elevation test?

Numbness to pins and needles or tingling, as well as some pain, as the ischemia to the nerve is released

What is the position of the patient's head during the Wright Test or Maneuver?

Rotated or extended

Which test is designed to assess the integrity of the bony structures of the upper limb from the humerus to the sternum?

Shoulder Olecranon Manubrium Percussion Sign

What does a dull sound during the Shoulder Olecranon Manubrium Percussion Sign indicate?

Fractured olecranon process of the ulna

Which position should the patient be in for the Shoulder Olecranon Manubrium Percussion Sign?

Sitting with elbows bent to 90°

What does a positive test result for thoracic outlet syndrome indicate?

Reproduction of symptoms

Which structure is primarily assessed during the Shoulder Olecranon Manubrium Percussion Sign?

Ulna

What is the purpose of the Pulse Disappearance test?

To assess for thoracic outlet syndrome

What is the primary purpose of the Bear-Hug Test?

To test the ability of ligaments to hold the biceps tendon in the bicipital groove

What is the primary purpose of the Reverse Impingement Sign?

To test for glenohumeral arthritis

Which nerve is the most commonly injured nerve in the shoulder?

Axillary nerve

What is the most common cause of injury to the axillary nerve?

Anterior dislocation of the shoulder

Which muscle is primarily affected by motor loss due to axillary nerve injury?

Deltoid

What is the main sensory loss associated with axillary nerve injury?

Loss over the deltoid with a small circular area at the deltoid insertion

Which nerve may be injured by a fall on the posterior shoulder or fracture of the scapula?

Suprascapular nerve

What is the main motor loss associated with suprascapular nerve injury?

Loss of abduction and lateral rotation of the shoulder

Which movement is performed to assess joint play in the humerus?

Backward joint play movement

What is the purpose of the caudal glide (long arm traction) joint play movement?

To assess joint play in the glenohumeral joint

Which joint is assessed by moving the clavicle in and out or up and down?

Sternoclavicular joint

What is the recommended hand position to apply a lateral distraction force to the glenohumeral joint?

With the flat of the hand

What is the correct position of the patient's arm during the backward joint play movement of the humerus in abduction?

Parallel to the patient's body

What is the purpose of the forward joint play movement of the humerus?

To assess joint play in the humerus

Which nerves in the shoulder region are often assessed during a reflex examination?

Pectoralis major, clavicular portion (C5 to C6) and sternocostal portion (C7 to C8 and T1)

Which nerve roots should the examiner be aware of when assessing reflexes in the shoulder region?

C7 to C8 and T1

What can be used to map differences in sensation between the two sides of the body?

Pinwheel

Where does true shoulder pain rarely extend below?

Elbow

Which joint tends to have localized pain in the affected joint and usually does not spread or radiate?

Acromioclavicular joint

Which syndrome should be considered if symptoms arise with abduction and lateral rotation of the arm in a throwing athlete?

Thoracic outlet syndrome

Which joint should be palpated for normal positioning in relation to the sternum and first rib?

Sternoclavicular joint

Which muscle inserts into the coracoid process?

Pectoralis major

Which muscle originates from the coracoid process?

Biceps brachii

Which muscle is palpated in the triangle made up of the superior border of pectoralis major, the clavicle, and the medial border of the deltoid?

Subscapularis

What is the recommended position for the patient during the Jobe relocation test?

Sitting

What is the angle between the ulna and the vertical used to quantify humeral retroversion?

Bicipital-forearm angle (BFA)

Which muscle is palpated 2 cm inferior to the anterior aspect of the acromion process during a shoulder examination?

Supraspinatus muscle

Which structure does the examiner palpate in the notch formed by the acromion and spine of the scapula with the clavicle during a shoulder examination?

Musculotendinous junction of the supraspinatus muscle

Which muscle is palpated under the pectoralis major tendon in the axilla during a shoulder examination?

Biceps brachii muscle

Which joint is assessed by palpating along the joint line superiorly and inferiorly on the anterior and posterior surfaces of the humerus during a shoulder examination?

Glenohumeral joint

Which structure is palpated in the axilla during a shoulder examination?

Brachial artery

What muscle insertion is palpated just distal to the insertion of the infraspinatus muscle during a shoulder examination?

Teres minor muscle

Which nerve is the most commonly injured in the shoulder?

Axillary nerve

What is the most common cause of injury to the axillary nerve?

Anterior dislocation of the shoulder

Which muscle is affected by the injury to the axillary nerve?

Deltoid

What is the main symptom of axillary nerve injury?

Inability to abduct the arm

Which nerve may be injured by a fall on the posterior shoulder or fracture of the scapula?

Suprascapular nerve

What muscles are affected by the injury to the suprascapular nerve?

Supraspinatus and infraspinatus

Which movement is primarily limited in a patient with scapular winging and medial rotation of the inferior angle on abduction?

Abduction

Which muscle is primarily responsible for shoulder medial rotation?

Infraspinatus

Which joint play movement is performed by applying a backward force to the humerus in a parallel position to the body?

Backward joint play movement

Which joint is assessed by gently grasping the clavicle and moving it in and out or up and down?

Acromioclavicular joint

Which joint play movement is performed by applying an anterior force to the humerus in a parallel position to the body?

Forward joint play movement

Which joint play movement is performed by applying a lateral distraction force to the glenohumeral joint?

Lateral distraction joint play movement

Which joint should be palpated for normal positioning in relation to the sternum and first rib?

Sternoclavicular joint

What muscle inserts into the coracoid process?

Subscapularis

What is the purpose of the de Anquin test?

To assess for humeral retroversion

What is the angle between the ulna and the vertical used to quantify?

Bicipital-forearm angle (BFA)

Which muscle is palpated in the triangle made up of the superior border of pectoralis major, the clavicle, and the medial border of the deltoid?

Subscapularis

What is the purpose of the Modified Neer Test?

To assess for impingement of the supraspinatus tendon

Which nerves in the shoulder region are often assessed for reflexes?

All of the above

Which nerves can be injured about the shoulder?

All of the above

What should the examiner be aware of when assessing reflexes in the shoulder region?

Both A and B

How can altered sensation be tested in the shoulder region?

Both A and B

Where does true shoulder pain rarely extend below?

Elbow

Where is pain in the acromioclavicular or sternoclavicular joint usually localized to?

Affected joint

Which muscle is palpated 2 cm inferior to the anterior aspect of the acromion process?

Supraspinatus muscle

What is the notch formed by the acromion and spine of the scapula called?

Suprascapular notch

Which muscle is palpated under the pectoralis major tendon by having the patient laterally rotate the humerus 30° while flexing and extending the elbow?

Biceps brachii muscle

What does a click or pop during shoulder movement indicate?

Dynamic instability of the long head of biceps

What does it mean if the examiner's fingers and thumb do not 'dip in' as they approach the glenohumeral joint?

The humeral head is sitting further posteriorly than it should

What can be palpated in the axilla with the shoulder slightly abducted?

Brachial artery

Which movement is typically associated with scapular winging?

Shoulder abduction

Which joint play movement is used to assess the backward movement of the humerus?

Caudal glide

Which joint play movement is used to assess the forward movement of the humerus?

Backward movement

Which joint play movement is used to apply a lateral distraction force to the glenohumeral joint?

Lateral distraction

Which nerve is the most commonly injured nerve in the shoulder?

Axillary nerve

What is the most common cause of axillary nerve injury?

Anterior dislocation of the shoulder

Which muscle is primarily affected by motor loss due to axillary nerve injury?

Deltoid

What is the main sensory loss associated with axillary nerve injury?

Loss at the deltoid insertion

Which joint should be palpated for normal positioning in relation to the sternum and first rib?

Sternoclavicular joint

Which muscle inserts into the coracoid process?

Subscapularis

What is the purpose of palpating the humerus and its surrounding structures for potential pathology?

To evaluate the rotator cuff muscles

What is the purpose of the Bicipital-Forearm Angle (BFA) test?

To quantify humeral retroversion

Which muscle is palpated 2 cm inferior to the anterior aspect of the acromion process during a shoulder examination?

Supraspinatus

What is the purpose of palpating the musculotendinous junction of the supraspinatus muscle during a shoulder examination?

To assess for dynamic instability of the long head of biceps

What is the purpose of palpating the glenohumeral joint line during a shoulder examination?

To assess for pain or the presence of pathology

Which structure cannot be palpated superiorly in the axilla during a shoulder examination?

Inferior glenohumeral joint

Which of the following reflexes in the shoulder region is assessed by running the relaxed hands and fingers over the neck, shoulders, and anterior and posterior chest area?

Pectoralis major, clavicular portion (C5 to C6)

Which of the following is true about dermatomes and cutaneous distribution of peripheral nerves?

Peripheral nerve lesion can be differentiated from a nerve root lesion referred from the cervical spine using sensation.

Which nerve can be injured before it branches off the brachial plexus as an individual nerve?

Axillary (Circumflex) Nerve (C5 to C6)

Which of the following is true about pain in the shoulder and surrounding tissues?

Pain can be referred to the shoulder and surrounding tissues from the cervical spine, elbow, and lungs.

Which spinous process is located at the level of the superior angle of the scapula?

T2

Between which two spinous processes does the base or root of the spine of the scapula lie?

T3 and T4

Where does the inferior angle of the scapula lie?

T7 and T9

What muscle can be palpated along the medial border and spine of the scapula?

Trapezius

What muscle can be palpated at the inferior angle of the scapula?

Latissimus dorsi

What muscle can be palpated against the lateral border and along the ribs of the scapula?

Serratus anterior

What muscles can be palpated near the glenoid?

Long head of triceps and Teres minor

What muscles can be palpated on the posterior surface of the scapula?

Supraspinatus and Infraspinatus

What muscles can be palpated just under and slightly inferior to the posterior aspect of the acromion during a specific arm position?

Supraspinatus and Infraspinatus

Test your knowledge of the biceps and rotator cuff muscles' role in shoulder stability and motion with this quiz. Learn about their functions in stabilizing the glenohumeral joint and controlling humeral head movement.

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