physiological movement
natural, osteokinematic movements of the joints
osteokinematics
basic joint movements: flex/ext, AB/ADduction, IR/ER
athrokinematics
movement between articular surfaces of a joint
active movement testing
patient goes thru the ROM actively, no hands on by PT. PT observes looking for asterisk point or cardinal sign. if patient has full ROM and no pain, apply overpressure during this part of exam to clear the joint. clear joints above and below the pt complaint.
resistive movement testing
Tests contractile tissues of the joint. Isometric testing with the limb supported in the rest position. no arc of movement. used to rule out/in musculo-tendinous injury
passive movement testing
Tests NON-Contractile tissues of the joint. tests accessory movements of the joint. Passive physiologic movement, joint mobility (arthrokinematic actions). Include joints above and below the affected joint.
PMT for the scapulothoracic joint (glides)
elevation/depression, AB/ADDuction, upward/downward rotation, distraction
PMT for the SC joint (glides)
superior medial, inferior lateral glide, AP glide, PA glide. pt supine
PMT for the AC joint (glides)
AP glide, PA glide (pressing anterior and slightly lateral)
PMT for the GH joint (glides)
lateral distraction, Ant glide, post glide, inferior glide, ER, IR, longitudinal glide, pt supine
to increase elevation, perform _______ at the SC joint
inferior glide
to increase depression, perform _______ at the SC joint
superior glide
to increase protraction, perform _______ at the SC joint
P-A glide
to increase retraction, perform _______ at the SC joint
A-P glide
to increase flexion and ABDuction in GH joint, perform _______ (mobilization)
inferior glide
PMT scapulothoracic body positioning
pt side lying facing me, place scapula flat on patient’s back, grasp inferior angle and superior angle or acromion. Pt’s back is neutral and no rotation is allowed.
GH rest position
50-55 degrees ABduction and 30 degrees horizontal adduction
sensitivity
proportion of people who test positive with the clinical test and the gold standard relative to all patients who test positive with the gold standard (% of correctly identified positives)
specificity
proportion of people who test negative with the clinical test and the gold standard relative to all patients tested who test positive with the gold standard. % or correctly identified negatives.
postitive predictive value
proportion of people who truly have the condition relative to all patients who test positive
negative predictive value
proportion of people who truly do not have the condition relative to all patients who test negative
anterior apprehension test
neutral ABD of the arm, elbow bent 90°. ER to see if patient is apprehensive about it.
anterior drawer test
arm ABducted to 90 degrees w/ external rotation, apply PA force to the proximal humerus.
jobe relocation test
if the head of the humerus dislocates anteriorly during the anterior drawer or the anterior apprehension test, press posteriorly or internally rotate the humerus to pop it back in place.
posterior apprehension test
shoulder flexed to 90° (pt’s hand falling towards opposite shoulder), press posteriorly thru length of humerus with hand on pt’s elbow
posterior drawer test
posterior glide with 45-50° ABD, but no horizontal ADD
sulcus sign
feel for sulcus sign (indicating subluxation) just lateral and inferior to acromion while patient is sitting or standing with arm unsupported. Measured by number of finger.
Faegin test
test for inferior instability. stand facing pt’s side with their arm ABD to 90° and resting on your shoulder. Depress the humerus in the glenoid with ulnar side of your hand on top of the head of the humerus close to the joint.
Rowe test for multidirectional instability
Pt standing, bent over with arm hanging. Stabilize the scapula and perform anterior, inferior and posterior instability tests.
yergason test
hitchhiker test. tests the bicipital tendon: with arm ABD 10-20 degrees, palpate the bicipital tendon while resisting supination, external rotation and elbow flexion. Pain or “snap” are positive signs.
speed’s test (classic and second type)
classic: Pt sitting, 90 degree should flexion, arm ER, forearm supinated, elbow straight. resist isometic hold of shoulder flexion. or, in shoulder extension with arm externally rotated, resist flexion of shoulder. pain at bicipital groove with either test is a positive sign.
drop arm test
testing rotator cuff and deltoid as a dynamic stabilizers. Pt raises arm into ABD and slowly lowers it. Can add tap to the wrist if it’s not challenging the pt. ALWAYS be ready to catch the patient’s arm.
supraspinatus test
pt ABD arms in scapular plane anywhere from 15-30 but <90° w/ IR. Positive sign is pt’s inability to hold position with overpressure from PT.
empty/full can test
tests for rotator cuff tears. also tests supraspinatus. Arm elevated to 90° in plane of scapula. Thumb down (empty) or thumb up (full). PT resists pt in isometric contration. Positive sign=pain and weakness.
hawkins-kennedy
impingement test. arm at 90 degrees shoulder flexion or in plane of scapula, elbow at 90, PT overpressure the arm into IR (arm wrestling)
yocum test
hand of the affected arm placed on opposite shoulder and pt is instructed to lift the elbow
neer test
“neer to the ear”-passive flexion of the arm while in internal rotation
crank test
similar to scour test.arm in 160°GH ABD in the scapular plane, elbow flexed to 90°. Stabilize pt’s posterior shoulder and push humerus into the joint with force thru the elbow while taking pt thru IR and ER. Positive sign=pain with ER or reproduction of the sardinal sign during overhead activities
O’Brien’s test
Active compression test- arm flexed to 90°, IR, elbow straight then horizontally adduct. Part 1: PT resists with downward force. Part 2: pt turns palm up and PT resists downward force. Positive sign: pain with part 1 only rules in labral damage. Pain in both parts suggests possible AC joint invovlvement and rules OUT the labrum b/c changing the degree of compression did not change results.
mimori new pain provocation test
Part 1: PT lifts arm into ABD to 90 degrees at shoulder and elbow with forearm pronated. Part 2: same position with forearm supinated. Positive sign: pain provoked with pronation or pain greater in pronation that supination. suggests superior labrum tear/injury
biceps load test
pt supine-same as anterior apprehension test but add resistance to isometric elbow flexion at 90 degrees. positive sign=apprehension when elbow flexion is resisted. negative sign: if resisted elbow flexion relieves the sx. can do step 2 with forearm pronated.
sulcus test
stabilize under the glenoid w/ pt seated and pull humerus inferiorly from the elbow/forearm to check for inferior instability
Rockwood test for anterior instability
arm flexed to 180°, ER, elbow bent to 90° so forearm is overhead. Arm pressed backwards and you feel the back of the capsule.
speed’s test in shoulder extension
pt seated, shoulder ext, ER, Elbow straight, PT resists isometric flexion of shoulder. pain is a positive sign.
SLAP lesion
superior labrum anterior to posterior.
HYN
special tests for impingement: Hawkins-Kennedy, Yocum, Neer Test
COMB
special tests for labral tears: Crank test, O’brien’s test, Mimori new Pain Provocation test, Biceps load test.
tests for rotator cuff
drop arm, supraspinatus test, Empty/Full can test,
biceps tendon special test
Speed’s test
if there is a history of dislocation you should definitely check for…
labral tear
AC ROM
Tipping=30, winging=30-50, abd/add=20-30
SC ROM
Depression=5, pro/retraction=15, rotation (spin)=30, elevation=45-60
GH ROM
Abd/flexion=120, ext=55, IR=60-70, ER=90,