Approach to Shoulder Complaint

Question 1

shoulder flexion ROM

Answer 1

180°

Question 2

shoulder extension ROM

Answer 2

60°

Question 3

shoulder abduction ROM

Answer 3

180°

Question 4

shoulder internal/external ROM

Answer 4

90°

Question 5

shoulder horizontal abduction ROM

Answer 5

40-55°

Question 6

shoulder horizonal adduction ROM

Answer 6

130-140°

Question 7

dermatome over the AC joint

Answer 7

C4

Question 8

dermatome over the lateral aspect of the lower edge of the deltoid muscle moving into the anterior middle portion of arm and forearm

Answer 8

C5

Question 9

dermatome of radial side of forearm and thumb

Answer 9

C6

Question 10

dermatome of palmar side of middle finger and posterior middle portion of arm and forearm

Answer 10

C7

Question 11

dermatome of the 5th digit and medial portion of arm and forearm

Answer 11

C8

Question 12

dermatome of the medial aspect of antecubital fossa, proximal to the medial epicondyle of the humerus

Answer 12

T1

Question 13

dermatomes of the biceps and brachioradialis Ms.

Answer 13

C5-6

Question 14

dermatomes of the triceps M.

Answer 14

C6-7

Question 15

• patient: shoulder abducted to 90° and elbow flexed to 90°
• stabalize shoulder and force arm into external rotation
• (+) test: patient apprehension
• indicates: glenohumeral instability

Answer 15

apprehension test

Question 16

• patient: flex shoulder to 90° and abduct to 45°
• internally rotate arms so thumbs are pointed down, press down on forearms while patient resists
• (+) test: pain or weakness
• indicates: supraspinatus pathology

Answer 16

empty can test

Question 17

• patient: abducts arm to 90°, then slowly drops arm to neutral, can also be down w/ gentle tap on the wrist
• (+) test: uncontrolled arm drop
• indicates: supraspinatus pathology

Answer 17

drop arm test

Question 18

• patient: abducts arm starting at neutral
• (+) test: pain between 60-120° of abduction
• indicates: subacromial bursa impingement and/or rotator cuff injury

Answer 18

painful arc test

Question 19

• stabalize shoulder and pronate forearm outward, passively flex shoulder into full flexion
• (+) test: pain
• indicates: subacromial bursa impingement or rotator cuff impingement

Answer 19

Neer’s Test or Neer’s Impingement

(“Neer to the Ear”)

Question 20

• patient: flex shoulder to 90° and elbow to 90°
• passively internally rotate shoulder
• (+) test: pain
• indicates: subacromial bursa impingement or rotator cuff impingement

Answer 20

Hawkin’s Test

Question 21

• passively adduct arm across patient’s chest and rest patient’s hand on their opposite shoulder
• monitor posterior aspect of AC joint
• (+) test: AC joint pain or increased TTA’s
• indicates: AC joint pathology

Answer 21

Cross Arm Test

Question 22

Most common type of shoulder dislocation:

Answer 22

anterior dislocation (95-97% of cases)

Question 23

Most common rotator cuff tendon to be injured:

Answer 23

supraspinatus

Question 24

Most common causes of shoulder pain:

Answer 24

rotator cuff injuries (acute) and myofascial injuries (acute)

Question 25

scapular depression causes distal clavicle (AC joint) to ______ \_\_\_\_\_\_ and proximal clavicle (SC joint) to ______ \_\_\_\_\_\_

Answer 25

scapular depression causes distal clavicle (AC joint) to **inferior glide (clavicle inferior to acromion)** and proximal clavicle (SC joint) to **superior glide (clavicle superior to sternum)** \*vice versa for scapular elevation\*

Question 26

- GH joint motion: adduction - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 26

- GH joint motion: adduction - scapular motion: depression - clavicle AC joint: inferior glide - clavicle SC joint: superior glide

Question 27

- GH joint motion: abduction - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 27

- GH joint motion: abduction - scapular motion: elevation - clavicle AC joint: superior glide - clavicle SC joint: inferior glide

Question 28

- GH joint motion: flexion - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 28

- GH joint motion: flexion - scapular motion: protraction - clavicle AC joint: anterior glide - clavicle SC joint: posterior glide

Question 29

- GH joint motion: extension - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 29

- GH joint motion: extension - scapular motion: retraction - clavicle AC joint: posterior glide - clavicle SC joint: anterior glide

Question 30

- GH joint motion: internal rotation - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 30

- GH joint motion: internal rotation - scapular motion: n/a - clavicle AC joint: internal rotation - clavicle SC joint: n/a

Question 31

- GH joint motion: external rotation - scapular motion: - clavicle AC joint: - clavicle SC joint:

Answer 31

- GH joint motion: external rotation - scapular motion: n/a - clavicle AC joint: external rotation - clavicle SC joint: n/a

Question 32

- glenohumeral joint tx - patient lays prone w/ arm off table - grasp humeral head and assess ease and restriction by using distraction, compression, twist, and shear - engage either direct or indirect barrier until release is felt

Answer 32

shoulder myofascial release

Question 33

- GH joint tx - engage 7 stages of articulatory movement of shoulder: ext/flex, compression circumduction, traction circumduction, abduction w/ ext rot, adduction, internal rot, traction w/ inferior glide - patient lays lateral recumbent w/ involved shoulder up - MET can be included once restrictive barrier has been engaged

Answer 33

Spencer's Technique

Question 34

- AC tx - doc: ipsilateral side or behind patient - grasp elbow or forearm and monitor clavicle between thumb and fingers - apply anterior/inferior pressure w/ thumb on lateral clavicle while flexing patient's elbow; extending and adducting humerus (to gap AC joint) - **shoulder is moved into a circulatory sweep**, posterior, superior, then anteromedial

Answer 34

superior clavicle articulatory technique

Question 35

- patient: supine w/ neck fully flexed by physician - doc: thumb over sternal end of clavicle, exerting a **downward/caudal pressure** on the clavicle - patient instructed to inhale and exhale fully, during exhalation, physician springs the clavicle inferiorly/caudally - tx: **elevated SC joint = adducted SC joint**

Answer 35

adducted SD articulatory technique

Question 36

- patient: supine - doc: ipsilateral side - monitor at clavicular head and place other hand behind scapula, patient holds physician's shoulder - physician flexes the clavicle toward the manubrium pulling scapula anteriorly - **posterior force** simultaneously applied to proximal clavicle from anterior to posterior to engage restrictive barrier - apply principles of MET - tx: **anterior SC joint = extension SC joint**

Answer 36

extension SD MET

Question 37

- patient: supine - doc: ipsilateral side - monitor on the sternal clavicular head, place arm into **extension and internal rotation** - patient is instructed to **raise arm** against physician's hand toward ceiling applying principles of MET - tx: **elevated SC joint = adducted SC joint**

Answer 37

adducted SD MET

Question 38

- patient: supine - doc: contralateral side - patient gaps the SC joint by adducting th ipsilateral arm (using their contralateral hand to aid in the motion) - articulatory springing is applied laterally, posteriorly, and inferiorly over medial end of clavicle - tx: **anterior SC joint = extension SC**

Answer 38

extension SD articulatory technique