fall 2023 CP practical final Flashcards
apley scratch test
purpose: ROM (abduction, flexion, external rotation, pronation, adduction, extension, internal rotation and supination)
Pt. pos: standing
prac. pos.: behind pt.
procedure: pt. is asked to touch both hands together behind the back with one arm going over the shoulder and the other arm under the shoulder
positive: asymmetry
spring test (SC)
purpose: sterno-clavicular joint (anterior and posterior sc ligaments, costo-clavicular lig. and inter clavicle lig.)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers placed on proximal clavicle
procedure: prac. pushes clavicle posteriorly and inferiorly. done several repetitions and performed bilaterally
positive: excessive movement of proximal clavicle as it springs back into place
spring test (AC)
purpose: acromio-clavicular ligament (superior and inferior acromio-clavicular ligament, conoid and trapezoid portion of CC ligament)
Pt. pos: standing
prac. pos.: in front of pt. 2-3 fingers on distal clavicle
procedure: push distal clavicle inferiorly. done several repetition and performed bilaterally
positive: excessive movement of distal clavicle
AC/ SC compression test or crossover test
purpose: check sc or ac joints or clavicle fracture
Pt. pos: seated or standing, affected arm brought across the body and rests on the opposite shoulder
prac. pos.: in front of pt., hand on the pt.s affected elbow
procedure: push elbow to opposite shoulder
positive: pain in either the AC or SC joint or clavicle
AC shear test
purpose: check AC joint (superior and inferior ac lig., conoid and trapezoid portion of CC lig)
Pt. pos: standing or sitting
prac. pos.: in front of pt. interlaced fingers are placed over the spine of the scapula and mid-clavicle
procedure: prac. squeezes scapula and mid clavicle
positive: excessive movement of the distal clavicle; pain
traction
purpose: check AC joint (& associated ligaments), stability of the inferior glenohumeral joint
Pt. pos: standing with arms at the side
prac. pos.: standing in front of pt. grasping pt.’s wrists
procedure: prac. pulls uniformly down on each arm and looking for step up or sulcus sign
positive: step off of AC joint and pain AND/OR sulcus sign seen on superior, anterior shoulder and pain and instability
apprehension (crank) test
GOLD STANDARD FOR SHOULDER INSTABILITY
purpose: anterior/ inferior shoulder instability
Pt. pos: can be standing or lying supine
prac. pos.: standing: in front of Pt. with one hand on wrist and other on elbow, bring arm into external rotation. Supine: one hand can be placed on mid forearm with thumb up the forearm and one hand pushing gh joint back to push the humerus back into place
procedure: move the humerus into abduction and external rotation, look for facial expression
positive: facial expression that indicate pain, pt. feels instability or apprehension with ROM
relocation (fowler or Jobe or surprise) test
purpose: confirmation of a positive apprehension test
Pt. pos: supine, arm abducted and external rotated
prac. pos.: to the side of pt. one hand on wrist and the other on the anterior shoulder
procedure: once an uncomfortable or painful ROM in apprehension, prac. places the palm of hand over the anterior shoulder while maintaining the abducted and externally rotated position, the hand can be pushed down and releases to discern pain levels
positive: a relief of pain levels with pressure or release of pressure on anterior GH
adson
purpose: Thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: standing behind pt.
procedure: prac. feels for radial pulse, externally rotate and extends the shoulders. pt. is instructed to look towards the effected Side and hold breath for 10-15 sec.
positive: reduced or diminished pulse
allen’s (wright’s) test
purpose: thoracic outlet syndrome
Pt. pos: sitting
prac. pos.: behind pt.
procedure: prac. finds radial pulse and abducts and externally rotates (90 90). pt. is then instructed to look away from the affected side (for Wright’s test= take arm into hyperabduction and check for pulse)
positive: reduced or diminished radial pulse
speeds
purpose: tendinitis of long head of the biceps
Pt. pos: standing with arms at 90 degrees of forward flexion and supination
prac. pos.: facing pt. with one hand on the bicipital groove and the other hand on the distal wrist
procedure: pt instructed to hold at 90 degrees while the prac. provides resistance into flexion
positive: pain and/or inability to complete the maneuver, or crepitus at the biceps tendon
Yergason’s
purpose: bicipital tendonitis, or rupture of the transverse humeral ligament
Pt. pos: sitting, elbow straight, internally rotated and pronated
prac. pos.: next to pt. one hand on the bicipital groove and other hand on the distal wrist
procedure: pt. instructed to move from an internally rotated and pronated position to external rotation and supination against resistance. start in pronation and extension then resist against supination and elbow flexion
positive: pain in bicipital groove, long head of the biceps moving out of the bicipital groove, weakness
empty can
purpose: isolated contraction of the supraspinatus muscle
Pt. pos: standing with arms raised to 90 degrees, horizontal abducted to 45 degrees and pronated (thumb down)
prac. pos.: in front of pt. one hand stabilizing shoulder and the other on the distal wrist
procedure: pt is instructed to resist downward movement through the motion of the scaption. perform with both arms at the same time
positive: pain, inability to complete maneuver
impingement
A
purpose: impingement, pinching long head of biceps tendon, supraspinatus, and sub-acromial bursa under coracoaromial ligament
Pt. pos: standing
prac. pos.: in front of pt. one hand on distal wrist and one hand supporting arm at the elbow
procedure: arm is take into forced abduction and external rotation
positive: anterior shoulder pain
painful arc
purpose: shoulder impingement
Pt. pos: standing with arms held at sides
prac. pos.: in front of pt. slight resistance may be placed on pt. wrists as needed
procedure: the pt. is instructed to move through full ROM in abduction from the hands at the side to fully overhead
positive: only pain in ROM from 45-120 degrees.
clunk
purpose: tear of glenoid labrum
Pt. pos: supine with arm flexed fully overhead
prac. pos.: standing at head of pt. with both hands under and grasping the head of the humerus
procedure: push arm straight in towards the body and lift humerus straight up towards the ceiling.
positive: clunking, clicking, catching
drop arm
purpose: tear of the rotator cuff musculature
Pt. pos: standing with arms abducted to 90 degrees
prac. pos.: standing in font of pt., hands may be placed on pt.s wrist as necessary
procedure: pt. is instructed to slowly lower arms. prac. may add resistance pushing arms down
positive: pain, an inability to slowly lower arms, sudden dropping of one arm
hawkins- Kennedy impingement
GOLD STANDARD FOR SHOULDER IMPINGEMENT
purpose: shoulder impingement
Pt. pos: standing with shoulder flexed to 90 degrees and internally rotated
prac. pos.: standing in front of pt. one hand supporting the elbow and the other on the distal forearm
procedure: downward pressure is applied on the wrist, while other Hand remains stationary
positive: pain, facial expression, apprehension
neer impingement
A
purpose: shoulder impingement
Pt. pos: standing
prac. pos.: standing next to pt. one hand stabilizing the scapular region and the other hand placed on distal wrist
procedure: shoulder is taken into full flexion and the practitioner applies a slight overpressure. pressure to scapula forward
positive: pain
pectorals major contracture
purpose: tightness through pectorals major muscle
Pt. pos: lying on back with fingers laced behind head
prac. pos.: standing at head of pt. with hands on elbows if needed
procedure: pt. is instructed to allow the elbows to relax and try to touch the table; pressure by the prac. may be performed to check end feels
positive: inability to move elbows closer to the table
Military brace position (eden test)
purpose: costo-clavicular syndrome
pt. pos: standing with arms to the side and supinated
prac. pos: standing behind pt. with fingers on radial pulse and the other hand on the clavicle
procedure: redial pulse is palpated and the shoulder is drawn down and back with slight traction. hand over from scapula to clavicle squeezes while other hand is palpating radial pulse
positive: decreased or diminished pulse
anterior/ posterior drawer test
purpose: posterior shoulder instability
pt. pos: sitting relaxed with forearm RESTING on thigh
prac. pos: next to pt. one hand stabilizing hand on spine of scapula and clavicle and the other hand over the head of the humerus
procedure: head of humerus is moved anterior and posteriorly while other hand stabilizes
positive: excessive movement at GH joint and or pain
Load and Shift
purpose: Labral tears
pt. pos: sitting, relaxed, forearm relaxed on thigh
prac. pos: next to pt. one hand stabilizing of scapula and clavicle and other hand over the head of the humerus
procedure: same procedure as anterior/ posterior drawer + pressure applied on humerus towards the joint
positive: pain, clicking, and/or catching
Rowe test
purpose: GH instability (ligaments structures)
pt. pos: supine with hands behind the head
prac. pos: balled fist under posterior head of humerus and other hand on top of bent elbow
procedure: downward pressure is applied at the elbow towards the table
positive: pain, anterior instability
posterior apprehension (humeral shear or posterior glide)
purpose: posterior shoulder instability
pt. pos: supine, forward flexion to 90 degrees elbow bent to 90 degrees
prac. pos: standing next to pt., one hand on pt. elbow
procedure: humerus is pushed posteriorly straight back
positive: pain, excessive glide of humerus, apprehension
Liu Crank
purpose: Labral tear
pt. pos: supine arm abducted to 160 degrees with 30 degrees of horz. adduction
prac. pos: standing next to pt. hand on pt. elbow
procedure: humerus is pushed back posteriorly and the arm is taken into internal and external rotation
positive: pain, clicking, apprehension, especially with external rotation
bear hug
purpose: subscapularis weakness or neuro deficit
pt. pos: standing, arm resting of opposite shoulder with the shoulder flexed to 90 degrees
prac. pos: put hand under pt. hand that is one opposite shoulder. standing in front of pt.
procedure: pt is instructed to maintain the position and push down on the opposite shoulder
positive: pain and/or inability to push down
lift off sign (belly lift off)
A
purpose: subscapularis weakness or neruo deficit
pt. pos: standing arm internally rotated and resting on low back
prac. pos: behind pt. with one hand on the mid humerus and other hand on the distal wrist
procedure: slight resistance may be applied by the prac. as the pt. attempts to lift the hand off the low back
positive: pain and/or inability to raise hand
feagin (inferior drawer)
purpose: shoulder instability (inferior middle and superior gh ligaments)
pt. pos: standing with arm abducted to 90 degrees or flexion to 90 degrees
prac. pos: shoulder abduction: standing next to pt. with both hands on top of head of humerus OR shoulder flexion: standing in front of pt. with both hands on top of humerus
procedure: with both hands on top of humerus head, a downward force is applied
positive: instability of the GH joint and/or anterior sulcus and/or pain
Roos
purpose: thoracic outlet syndrome
pt. pos: abducted and externally rotated arms (90 90 field goal position) with hands open
prac. pos: next to pt.
procedure: pt is instructed to open and close hands for 3 minutes
positive: decrease in motor function of the hand, loss of sensation, inability to maintain test position
O’brien’s
purpose: SLAP lesion
pt. pos: sitting or standing, shoulder flexion to 90 degrees, full horz. adduction and full internal rotation
prac. pos: in front of pt. one hand on the elbow and other on the distal wrist
procedure: pt is instructed to resist against the downward force of the prac. The test is repeated wit external rotation. have pt go from opposite asis to opposite shoulder
positive: pain and/or popping that is alleviated with the external rotation component
shoulder scouring
purpose: instability of the GH joint, labral tears
pt. pos: sidling, arm abducted to 90 degrees
prac. pos: standing behind pt., pt arm is resting on prac. elbow/ forearm. one hand on lateral joint line on the proximal humerus, the other hand stabilizing the scapula posteriorly
procedure: anterior and inferior and posterior and superior forces are placed on the humerus, feeling for instability or clicking or popping
positive: clicking or popping (labrum); instability or apprehension (ligamentous instability)
SLAP series
purpose: slap lesion, particularly from the bicipital pull on the superior labrum
pt. pos: supine with arm hanging off the table. pt. abducts arm to 120 degrees, shoulder rotation neutral, pronated and elbow flexed to 65-70 degrees
prac. pos: standing next to pt. one hand is stabilizing the upper arm mid humerus while the other grasps the pt. wrist
procedure: the pt is instructed to spinate the hand against maximal resistance while the pt. moves the shoulder into full abduction and external rotation (1). the elbow is then flexed against maximal resistance (2)
positive: clicking or popping, pain deep in the GH joint with resisted actions of supination (1) or elbow flexion (2)
predictability/ percentage: 81-96%
valgus stress
purpose: test integrity of ulnar collateral ligament
pt. pos.: seated with arms in anatomical position
prac. pos.: standing in front of pt. supporting arm, one hand at lateral elbow and other is placed on medial distal arm near wrist
procedure: valus stress is applied to elbow at 0 and at 30 degrees of flexion
positive: increased valgus movement with a diminished or absent end point
varus stress
purpose: test integrity of radial collateral ligament
pt. pos.: seated with arms in anatomical position
prac. pos.: standing in front of pt. supporting arm, one hand at lateral elbow and other is placed on medial distal arm near wrist
procedure: varus stress is applied to elbow at 0 and at 30 degrees of flexion
positive: increased varus movement with a diminished or absent end point