Shoulder

Question 1

What is inspected for in a shoulder anteriorily?

Answer 1

• Slings?
• Asymmetry of shoulder girdle
• Scars
• Deltoid wasting
• Step deformity
• Lump in antecubital fossa
• Swelling

Question 2

What is inspected for in a shoulder laterally?

Answer 2

Scars

Question 3

What is inspected for in a shoulder posteriorly?

Answer 3

• Winged scapula
• Scoliosis
• Tarpezius and deltoid wasting/bulk
• Paravertebral muscles - swelling/wasting
• Supra/infraspinatus fossa muscle wasting

Question 4

c

Answer 4

c

Question 5

c

Answer 5

c

Question 6

c

Answer 6

c

Question 7

c

Answer 7

c

Question 8

c

Answer 8

c

Question 9

c

Answer 9

c

Question 10

What should be felt for in the shoulder?

Answer 10

• Temperature

- Tenderness/swelling in shoulder girdle

Question 11

What does temperature indicate in the shoulder?

Answer 11

• Inflammatory arthropathy

- Infection

Question 12

Palpation of shoulder girdle

Answer 12

• Sterno-clavicular joint
• Clavicle
• Acromio-clavicular joint
• Coracoid process – 2cm inferior and medial to the clavicular tip
• Head of humerus
• Greater tuberosity of humerus
• Spine of scapula

Question 13

Surface anatomy of coracoid process? 2 attachments?

Answer 13

2cm inferior and medial to the clavicular tip

• Short head of biceps
• Pec minor

Question 14

What screening shoulder compound movements are used? (2)

Answer 14

• Place hands behind head

- Move hands far up back

Question 15

Put your hands behind your head - functions assessed? (2)

Answer 15

• External rotation

- Abduction

Question 16

Put your hands as far up your back as you can - function assessed?

Answer 16

Internal rotation

Question 17

What specific active shoulder movements should be assessed? And how? (6)

Answer 17

• Lift arm backwards keeping them straight (extension)
• Raise arms forwards until points upwards (flexion)
• Lift arms away from sides as far as possible until top (abduction)
• Bring arms across trunk to opposite sides (adduction)
• Tuck elbows in like riding a bike then
  a) Bring elbows out (external rotation)
  b) Bring elbows in (internal rotation) then reach up back

Question 18

Normal ROM for shoulder flexion

Answer 18

150-180

Question 19

Normal ROM for shoulder extension

Answer 19

40

Question 20

Normal ROM for shoulder abduction

Answer 20

Up to 180

Question 21

Normal ROM for shoulder adduction

Answer 21

30-40

Question 22

Normal ROM for external rotation

Answer 22

80-90

Question 23

Normal ROM for internal rotation

Answer 23

T4-T8

Question 24

If aduction is painful 70-120 what is this a sign of?

Answer 24

Subacromial impingement

Question 25

If aduction is painful 140-170 what is this a sign of?

Answer 25

AC joint disruption

Question 26

What does passive movement assess for?

Answer 26

Crepitis

Question 27

What 2 shoulder conditions lead to generalised reducitions in passive as well as active range of movement? (other pathologies don't restrict passive) (2)

Answer 27

- Adhesive capsulitis | - Glenohumeral joint arthirtus

Question 28

Which movements are most effected by glenohumeral joint pathology (osteoarthiritus + adhesive capsulitus)? (2)

Answer 28

- External rotation | - Abduction

Question 29

How is the scapula assessed? (3)

Answer 29

- Ask patient to abduct shoulder - + Palpage inferior pole of scapula (hand around armpit) - Assess degree and smoothness of scapular movement

Question 30

When does scapula dysfunction occur?

Answer 30

Impingement

Question 31

Name the special shoulder tests

Answer 31

- Supraspinatus = "empty can" - Impingement of supraspinatus = "Painful arc" - Capsulitis/AC joint pathology = "scarf test

Question 32

What does a positive scarf test indicate?

Answer 32

Capsulitus/AC joint patholgy

Question 33

How to carry out scarf test? (2)

Answer 33

Get patient to stretch arm across to opposite shoulder and put hand on it - Then push elbow in to opposite shoulder

Question 34

What is a positive scarf test?

Answer 34

Pain felt specifc to AC joint (lateral end of clavicle) during horizontal adduction

Question 35

How to carry out empty can test? (4)

Answer 35

- Abduct arm by 90 - Angle arm forward by 30 (shoulder in plane of scapula) - Internally rotate arm so thumb down to floor - Then push down on arm - patient resists pressure

Question 36

Weakness in empty can test?

Answer 36

Weakness/impingment in supraspinatus