Shoulder

Question 1

Observation for shoulder

Answer 1

• Shoulder posture
• Step deformity
• Scapulohumeral rhythm

Question 2

AROM/PROM for shoulder

Answer 2

• Flexion/extension
• Abduction/adduction
• External/internal rotation

Question 3

Strength test for shoulder

Answer 3

• Flexion/extension
• Abduction/adduction
• External/internal rotation

Question 4

Special tests for shoulder

Answer 4

• Apley’s scratch test
• Wall push-up
• Hawkin’s Kennedy Impingement test
• Neer’s impingement
• Empty can test
• Speeds test
• Yergason’s test
• Cross arm test
• Depression of acromion
• Apprehension test
• Sulcus sign
• Anterior –> posterior glide

Question 5

Apley’s scratch test

Answer 5

• Hand behind hand over top

Question 6

Hawkin’s Kennedy Impingement test

Answer 6

• Hand out with arm 90 degree
• Have one hand on shoulder and the other pulling the arm down
• Observing for pain

Question 7

Neer’s impingement test

Answer 7

• Use one hand to depress scapula
• Use other hand to internally rotate shoulder then perform maximum shoulder flexion

Question 8

Empty can test

Answer 8

• Apply downward pressure

Question 9

Speeds Test

Answer 9

• Arm straight out supinated
• Push down on the forearm

Question 10

Yergason’s test

Answer 10

• Have patient in pronation
• Have hand on wrist area and tell patient to perform a bicep curl

Question 11

Cross arm test

Answer 11

• Have arm straight out 90 degrees
• Hand on elbow and passively adduct the shoulder while stabilizing the other shoulder

Question 12

Depression of acromion

Answer 12

• Palpate the acromion

Question 13

Apprehension test

Answer 13

• Lay on back
• Arm to 90 degrees and externally rotate

Question 13

Sulcus sign

Answer 13

• Grab elbow and pull down

Question 13

Anterior –> posterior glide

Answer 13

• Have patient laydown
• Hold patient arm in between your arm
• Put hand right below shoulder
• For anterior push upward
• For posterior push downward

Question 13

Assessment for shoulder impingement syndrome

Answer 13

• Painful in abduction
• Pain with apley’s scratch test
• Possible winging with wall push-up
• Positive hawkin’s kennedy test for pain
• Pain with neer’s impingement test
• Positive empty can test
• Pain over supraspinatus

Question 13

Palpation of shoulder

Answer 13

• Supraspinatus tendon
• Biceps tendon

Question 13

History for shoulder impingement syndrome

Answer 13

• Overuse of shoulder
• Overhead activities, throwing or swimming
• Pain with certain movements
• Worse with activity

Question 14

Injuries for the shoulder

Answer 14

• Shoulder impingement syndrome –> chronic
• Bicipital tendinopathy –> chronic
• Shoulder sprain/separation –> acute
• Shoulder dislocation/subluxation –> acute

Question 15

Treatment for shoulder impingement syndrome

Answer 15

• Correct biomechanics for shoulder
• Improve scapulohumeral rhythm –> shoulder blade squeezes
• Avoid overhead activities
• Rotator cuff strengthening –> External and internal rotation with resistance band

Question 16

History for bicipital tendinopathy

Answer 16

• Overhead activities
• Common in throwing sports
• Pain when raises arm forwards

Question 17

Assessment for bicipital tendinopathy

Answer 17

• Pain with active flexion above 90 degrees
• Pain with speed’s test and yergason’s test
• Pain on palpation of biceps tendon
• Might see scapulohumeral dysfunction
• Might see weakness with wall push-up

Question 18

Treatment for bicipital tendinopathy

Answer 18

• Treat biomechanics
• Modify aggravating activities –> avoid prolonged heavy gripping, lower intensity

Question 19

History for shoulder sprain/separation

Answer 19

• Trauma
• Fall on point of shoulder
• Hit by another player
• Common in contact sports

Question 20

Assessment for shoulder sprain/separation

Answer 20

- Limited ROM in all directions with pain - Limited strength in all directions with pain - Pain with cross arm test - Pain and laxity with acromial depression

Question 21

Treatment for shoulder sprain/separation

Answer 21

- Ice, sling - Restore ROM --> pendulum swings, front/back raises, internal external rotation - Pad around ACJ for return to sport - ACJ tape job - Refer to DR for x-ray if suspect clavicular fracture

Question 22

History for shoulder subluxation/dislocation

Answer 22

- Trauma - Athlete will have feeling of shoulder popping out - FOOSH injury - Shoulder might feel unstable

Question 23

Assessment for shoulder subluxation/dislocation

Answer 23

- Posture is slumped forward - If athlete tells you shoulder is out don't continue to assess --> hospital - Limited mobility into end range all movements - Positive apprehension test - Either positive sulcus sign, and/or anterior posterior glide

Question 24

Treatment for shoulder subluxation/dislocation

Answer 24

- Subluxation --> POLICE, strengthening program for rotator cuff, scapular stabilization - Dislocation --> treat as a fracture, immobilize, seek immediate medical attention, can start with pendulum exercises once out of sling