Ortho 2 (special tests/glides): Shoulder Flashcards
(73 cards)
1
Q
GH joint - observation (don’t forget 4 point palpation!)
A
Posterior
- Scoliosis, Scapula (Lower, protracted, Winging, Spine of scap - Any atrophy above (supraspinatus) below (infraspinatus))
Anterior
- Shoulders level, Clavicle asymmetry, Atrophy (pect, deltoid), LH biceps atrophy
Humeral head position (relative to acromion)
- Can use the four (4) Point Palpation to Ax it (One hand on acromion anteriorly & posteriorly, One hand on humeral head anteriorly & posteriorly)
- Normal (ant-post) = 1/3 anterior
- Abnormal: > 1/3 anterior or posterior, Inferior max 1 finger = inferior hypermobility/instability
Scapula normal position
- Inferior angle: around T7
- Sup angle: T2
- Look for any: Superior/inferior rotation, Internal rotation = Winging, Ant tilt, Winging, Lat distance med scap & SP (protraction)
2
Q
GH joint ROM/OP - flexion
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
3
Q
GH joint ROM/OP - extension
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
4
Q
GH joint ROM/OP - adbuction
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
5
Q
GH joint ROM/OP - synamic scapula assessment
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
6
Q
GH joint ROM/OP - IR
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
7
Q
GH joint ROM/OP - ER
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
8
Q
GH joint ROM/OP - horizontal add
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
9
Q
GH joint ROM/OP - horizontal abd
A
Done in standing
With every movts look at:
- HH movt
- Scap movt
- Any Tx or Lx extension (compensation)
10
Q
GH joint ROM/OP - Apley scratch test
A
11
Q
GH joint ROM/OP - HBB test
A
12
Q
GH joint PROM - flexion
A
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
13
Q
GH joint - prom abduction
A
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
14
Q
GH joint - prom ext
A
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
15
Q
GH joint - prom ER
A
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
16
Q
GH joint - prom IR
A
To do if:
- AROM limited
- GH pain with no AROM limitation (There could be some compensation from Scapula or Tx spine/ribs and Therefore need to Ax all GH PROM)
- Use goniometer to measure limitation (obj info)
Always assess contralateral side first
Done in supine
Stabilise scapula (sup or lat border)
Move humerus
Ax end feel (EF)
17
Q
GH joint - RISOM
A
18
Q
GH joint - palpation: greater tuberosity, bicipital groove, lesser tuberosity
A
19
Q
GH joint - palpation: supraspinatus tendon
A
20
Q
GH joint - palpation: infraspinatus tendon
A
21
Q
GH joint - palpation: teres minor tendon
A
22
Q
GH joint - palpation: subscapularis tendon
A
23
Q
GH joint - posterior glide
A
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
24
Q
GH joint - anterior glide
A
*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
25
GH joint - inferior glide
\*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
26
GH joint - traction and compression
\*Pt always in supine!
GH resting position
- Anterior glide (ER/Ext)
- Posterior glide (IR/Flex)
- Inferior glide (Abd)
- Traction/compression
27
GH joint: antero-superior HBB with ER
28
GH joint: apprehension test
29
GH joint: relocation test
\* to be done with apprehension test!!
30
GH joint - sulcus sign test
31
GH joint - posterior apprehension test
32
GH joint - compression rotation test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
33
GH joint - O'Brien's test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
34
GH joint - biceps load 2 test
Better diagnostic utility when using specific combination of 3 tests:
1) By selecting 2 highly sensitive tests (true positive)
- Compression rotation test
- O’Brien test
2) And 1 highly specific test (true negative)
- Biceps load II
User can be fairly confident in both ruling out & in SLAP lesions
35
GH joint - Hawkin's-Kennedy test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
36
GH joint - Neer's impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
37
GH joint - posterior impingement test
Both Hawkins-Kennedy & Neer tests would be minimally helpful for both ruling in & out subacromial impingement
The presence of a painful arc during elevation may additionally be helpful in identifying impingement
Impingement would not identify which structure is at fault would only identify which movt/mechanism is at fault
38
GH joint - full can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
39
GH joint - empty can test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
40
GH joint - drop arm test
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
41
GH joint - external rotation lag sign (ERLS)
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
42
GH joint - internal rotation lag sign
Remember:
Special tests done
- To isolate the involved structure
- Help to confirm the diagnosis
- But the result of a single test is usually not enough
43
GH sup lig stress test
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
44
GH mid lig stress test
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
45
GH inf lig stress test (ant segment)
## Footnote
Pt supine
Pht
Medial hand: Stabilizes scapula superiorly by applying a gentle pressure on the coracoid process
Lateral hand: Grasps proximal humerus
46
GH inf lig stress test (post segment)
47
Posterior GH ligaments stress tests
48
AC joint AROM
49
AC joint PROM ant rot
50
AC joint PROM post rot
51
AC joint - ant glide
52
AC joint post glide
53
AC joint inf glide
54
AC joint sup glide
55
AC joint compression
56
stability test trapezoid ligament
57
stability test conoid ligament
58
AC joint special tests
59
coracoclavicular joint special tests
61
SC joint - post glide
62
SC joint - inf glide
63
SC joint sup glide
64
SC joint ant glide
65
SC joint syability test (compression test)
66
SC joint syability test (anterior stability)
67
ST joint - 4-point palpation
68
Dynamic Scapula Test (bilat abd)
Bilateral abduction with thumbs up
69
Dynamic Scapula Test (abd elevation test)
To assess when Pt’s symptoms are produced in abduction & Scapula dysfunction is present
Pht corrects scapula position
- Stand behind your pt on the side of the shoulder being assessed
- Place one hand anteriorly over the acromion (your arm is between the pt’s arm and their body)
- The other hand is on the scapula posteriorly
- Correct the observed dysfunction (Eg: if the pt’s scapula is not upwardly rotating, create the upward rotation of the scapula with your hands)
- Ask pt to repeat GH abduction as you correct the scapula position & guide the scapula through abduction
\*Be aware not to block GH ROM as you are doing the correction q (+)ve test: Improve ROM or reduced pain
70
Dynamic Scapula Test (ER scapula stability test)
71
Scapula stability test (Kibler’s lateral slide - lateral scapula slide test)
72
scapula combined movements (ax ms flexibility)
73
scapula combined movements (ax ms strength)
90
SC joint ROM
Pt in sitting:
- Palpate the SC jt
- Assess using scapulo-thoracic physiological movts
Depression: Superior glide clavicle on sternum (♂)
Elevation: Inferior glide clavicle on sternum (♂)
Retraction: Posterior glide clavicle on sternum (♀)
Protraction: Anterior glide clavicle on sternum (♀)
