Physical Examination

Question 1

Which directions of mobility does the Apley “scratch” test determine?

Answer 1

Evaluates a patient’s RANGE OF MOTION

1) aBduction and external rotation: reach behind head and touch the superior medial angle of opposite scapula
2) aDduction and internal rotation: reach across chest and touch the opposite acromion

Question 2

What muscles and nerves are being tested by the Apley test for aBduction and external rotation?

Answer 2

ABduction: deltoid (axillary n.) and supraspinatus (suprascapular n.)
External (lateral) rotation: infraspinatus (suprascapular n.) & teres minor (axillary n.)

Question 3

What muscles and nerves are being tested by the Apley test for aDduction and internal rotation?

Answer 3

aDduction: teres major (lower subscapular n.) & latissmus dorsi (thoracodorsal n.)
Internal (medial) rotation: teres major (lower subscapular n.), subscapularis (upper & lower subscapular nn.) & latissmus dorsi (thoracodorsal n.)

Question 4

What does the Yearguson test test?

Answer 4

To test if the long head of the biceps brachii is in the bicipital groove, tell the patient to fully flex his elbow. Hold the elbow and wrist, externally rotate the arm as he resists and pull the elbow downward. It the biceps tendon is unstable, it will pop out of the groove and the patient will feel pain.

Question 5

What does the drop arm test determine?

Answer 5

It detects tears in the rotator cuff. Tell patient to abduct arm to 90 degrees and then lower it down slowly. If there is a tear, especially in the supraspinatus, the arm will drop, rather than smoothly adduct. TISS muscles are affected.

Question 6

Which internal organs may refer pain to the shoulder region?

Answer 6

The heart and lungs specifically. The liver may irritate the underside of the diaphragm which is innervated by the phrenic nerve - which would also refer pain to the shoulder region.