Shoulder Examination: general

Question 1

In the shoulder examination what is the general order?

Answer 1

• History and interview
• observation
• Scapular assessment
• tests and measures

Question 2

What is included in the HPI/history and interview for a shoulder exam

Answer 2

• What brings you in?
• When did your symptoms start? – acute/subacute/chronic
• How old are they?
  *Over 35 tend to have a primary shoulder impingement occurring due to spurs
  *Teens - 20s secondary impingement due to over use
• PMH:
• Patients goals
• Patients functional limitation

Question 3

What to observe and inspect during a shoulder examination

Answer 3

• Posture
• Symmetry
• Any atrophy
• Any edema
• How are they holding the body part

Question 4

What is part of a scapular assessment

Answer 4

1. S: scapular malpositioning:
   - Should be 2 inches from SP
   - Superior angle = T2
   - Root = T3
   - Inferior angle T8
2. I: inferior medial border prominence
3. C: coracoid process tenderness
   - Tight pec minor, biceps, coracobrachialis
4. K: scapular dysKinesis
   - Faulty movement
   - Inferior angle should end up in the mid axillary line

Question 5

Type 1 scapular dysfunction

Answer 5

• inferior dysfunction
• Associated with anterior tilting in sagittal plane
• Associated with rotator cuff dysfunction
• Joint space is more narrow

Question 6

Type 2 scapular dysfunction

Answer 6

• medial dysfunction
• associated with medial border prominence due to scapular IR in transverse plane
• Associated with GH instability

Question 7

Type 3 scapular dysfunction

Answer 7

• superior dysfunction
• associated with early scapular elevation during UE elevation
• associated with Deltoid RTC force couple imbalances

Question 8

What is the typical order of tests and measures during a shoulder examination

Answer 8

• UQS
• Differential exam:
• neuromuscular exam
• Special tests
• palpation
• outcome measure

Question 9

What is part of the differential exam in shoulder examination

Answer 9

• AROM: full or limited/painful or painless/quality of motion
• PROM: end feels
• Passive Mobility testing: joint play
• Resisted isometrics

Question 10

What is part of the neuromuscular exam

Answer 10

• MMT
• Sensory testing
• Reflexes

Question 11

Special tests for the scapula

Answer 11

• Scapular reposition test
• Scapular slide test

Question 12

Stability special test

Answer 12

• Sulcus sign
• Apprehension
• Relocation
• anterior/posterior drawer tests
• Fulcrum test
• Posterior apprehension
• Jerk test

Question 13

Labral special tests

Answer 13

• O’Brien
• Clunk
• Biceps load
• Biceps load II
• Anterior slide

Question 14

RTC special test

Answer 14

• Drop arm
• Supraspinatus
• Empty can
• Lift off and belly press

Question 15

Impingement special tests

Answer 15

• Neer test
• Hawkins - Kennedy
• Impingement sign
• Painful arc

Question 16

Biceps special tests

Answer 16

• Speed’s (static/dynamic)
• Yergason’s
• Transverse humeral ligament

Question 17

AC joint special tests

Answer 17

• Shear test
• Painful arc (above 140)
• Horizontal adduction (Cross over)

Question 18

What should you palpate?

Answer 18

• last so that you do make structures irritated
• Bony
• Joint
• Soft tissue

Question 19

Outcome measures for the shoulder

Answer 19

• Disabilities of arm, shoulder, and hand (DASH)
• Shoulder pain and disability index (SPADI)
• Penn shoulder score

Question 20

closed pack position for the shoulder

Answer 20

abducted and ER

Question 21

Glenoid resting position

Answer 21

5º superior tilt, 7º retroversion and angle between neck and shaft is 130º, humeral head is retroverted 30-40º

Question 22

Superior GH ligament
Middle GH ligament
Inferior GH ligament (what do they limit/when are they taut)

Answer 22

• superior glenohumeral ligament- inferior translation
• middle GH ligament - ER between 45– and 90º of abduction
• Inferior GH ligament - axillary pouch supports above 90º abduction/limits inferior translation