Shoulder Assessment PDF

Shoulder Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* Bony Palpation Bony Palpation Supra-sternal notch Sternoclacicular joint Clavicle Coracoid process Acromioclavicular articulation Acromium Greater tuberosity of humerous Spine of...

Shoulder Assessment *What follows is key observations, anatomy palpation, ranges of motion, & special orthopaedic tests* Bony Palpation Bony Palpation Supra-sternal notch Sternoclacicular joint Clavicle Coracoid process Acromioclavicular articulation Acromium Greater tuberosity of humerous Spine of scapula (level with T3) Vertebral (medial) border of scapula Humerus Greater and Lesser Tubercle Soft Tissue Palpation Rotator Cuff Composed of 4 muscles (SITS): Supraspinatus Infraspinatus Teres Minor Subscapularis Subacromial and Sub-deltoid Bursa Portions of these bursa are palpable under the acromial edge. Sternocleidomastoid (SCM) Pectoralis major Costochondral junction lies just lateral to sternum Biceps Deltoid Trapezius Rhomboid minor and major Latisimus dorsi Serratus anterior Ranges of Motion of Shoulder Active ROM (AROM) - Patient copies movement of practitioner or is told to move in particular direction Movements should be done in an order such that expected painful ones are done last and no residual pain is carried over from the previous movement. If very acute, some movements may be left out to avoid exacerbation of symptoms. Active ROM: Flexion = 180 Degrees Extension = 60 Degrees Abduction = 180 Degrees Horizontal Adduction = 50-75 Rotation = Internal is 90°, and external is 90°. Passive ROM Patient is standing Examiner applies an over pressure to the end of each active ROM to assess end feel Resisted ROM Patients is standing Examiner resists all of the shoulder AROM Assess for weakness Special Orthopaedic Tests AC Joint Assessments Cross arm test Passively adduct patient's arm across the chest wall with humerus parallel to the ground so free hand of the examined elbow rests on the opposite shoulder. Patient then pushes the elbow superiorly against the clinicians resistance. Positive = Pain with end-range adduction or with pushing arm up. Indicates = acromioclavicular joint pathology Active compression test Patient flexes arm to 90 degrees and adducts 10-15 degrees with internal rotation (thumbs down). The patient resists the examiners downward force. This maneuver is then repeated with the arms supinated. Positive = Pain in the AC joint or the shoulder during the first maneuver that improves or resolves with the second maneuver. Indicates = AC pathology if pain is in the AC joint, or a LABRAL (SLAP LESION) pathology if pain is felt more internal in the shoulder. Scapulothoracic Assessment Scapular winging Have patient do a push-up off the wall Positive = Scapula wings Indicates = weakness of Serratus anterior or long thoracic n. Bicipital Tendon Assessment Yergason's test Patient seated with elbow at side and forearm flexed to 90 degrees. Examiner palpates the long head of biceps with one hand while holding the wrist with the other. The Patient then simultaneously flexes their elbow and supinates their forearm against resistance. Positive = Tendon will pop out of the groove and cause significant pain. Indicates = Unstable bicipital tendon and subluxation Speed's test Shoulder in 90 degrees of forward flexion, elbow extended and hand supinated, with resistance applied downward. Positive = Pain in bicipital groove Indicates = Bicipital tendon pathology, usually tendinitis. Rotator Cuff Impingement Assessment Empty can test or Jobe’s Test Patient abducts both arms to 90 degrees and forward flexes 45 degrees with thumbs pointing down to the ground Patient then resists downward pressure. Positive = Weakness, pain, or dropping of the arm, which occurs in significant tears of the supraspinatus muscle with even a gentle tap to the forearm. Indicates = supraspinatus tendon tear (Can be more provocative of symptoms) Full Can test (NO PICTURE) Same as Empty Can except thumbs pointing to ceiling Patient then resists downward pressure. Positive = Weakness, pain, or dropping of the arm, which occurs in significant tears of the supraspinatus muscle with even a gentle tap to the forearm. Indicates = supraspinatus tendon tear. Neer Impingement Sign Examiner stabilizes patients shoulder on the top with his or her off hand, forward flexes the hummerus in the scapular plane to 180 degrees, with the arm medially rotated. Positive = Pain in shoulder Indicates = Impingement pathology, usually supraspinatus or biceps tendon Painful Arc Patient abducts arm overhead as far as they can go Positive = Pain with shoulder abduction between 70-100 degrees Indicates = rotator cuff impingement pathology, Pain starting after 100 degrees of abduction often suggests AC joint pathology, while pain immediately with abduction may indicate Frozen Shoulder Drop-Arm (Codman's) Test The examiner abducts the patient'S shoulder to 90° and then asks the patient to slowly lower the arm to their side in the same arc of movement Positive = if the patient is unable to return the arm to the side slowly or has severe pain when attempting to do so. Indicates = a tear in the rotator cuff complex. More specific to Supraspinatus Napoleon Sign Place patient’s hand on his or her stomach and have the patient push their palms into their stomach Positive = The elbow will drop backward. Indicates = Subscapularis weakness or injury Gerber's (Liftoff) Test This evaluates Subscapularis strength by limiting pectoralis major firing. The patient puts his or her hand behind the lumbar spine and attempts to lift the hand away from the back Positive = If the patient can not accomplish the liftoff Indicates = Subscapularis injury or weakness Gerber's (Liftoff) Test This evaluates Subscapularis strength by limiting pectoralis major firing. The patient puts his or her hand behind the lumbar spine and attempts to lift the hand away from the back Positive = If the patient can not accomplish the liftoff Indicates = Subscapularis injury or weakness Glenohumeral Instability Anterior Apprehension sign (CRANK) Patient is sitting or supine, arm is abducted to 90 degrees, elbow flexed to 90 degrees. The forearm is then forced into external rotation past 90 degrees. Positive = Patient will be very apprehensive and ask examiner to stop for fear of repeat dislocation. Indicates = Anterior glenohumeral instability, previous dislocation. Posterior apprehension sign Patient is lying down or sitting, examiner moves the patients arm into internal rotation, adduction and flexion. The examiner gently but firmly pushes posteriorly on the elbow. Positive = Pain, clunk, apprehensive look. Indicates = Posterior Instability due to Labral Pathology Clunk test Patient is supine examiner places a hand behind the humeral head the opposite hand holds the distal humerus and fully abducts the humerus over the patients head the examiner then pushes anteriorly (towards ceiling) on the humeral head the hand on the distal humerus then externally rotates the shoulder Positive = A clunk or grinding in the shoulder. Indicates = Labral pathology