Shoulder Assessment

Question 1

Observation

Answer 1

Scapula position (4pt grip)
- Anterior / posterior tilt
- IR / ER (winging)
- Elevation / depression
- Upward / downward rotation

ST Dynamic Movement
- Bilateral shoulder abduction

Question 2

Scapulothoracic Rhythm

Answer 2

First 30 degree abduction is GH joint.

Remaining ROM is 2:1 degrees GH to ST joint

Question 3

Bony Palpation

Answer 3

• SC Joint + Clavicle
• AC joint -> Acromion (lateral to AC)
• Coracoid process (biceps and pec minor)
• GT humerus (supraspinatus, infraspinatus + teres minor)
• Bicipital groove (LH biceps)

Question 4

Pectoralis Major and Minor

Answer 4

Pec Major
- O: Clavicular head: medial clavicle
- O: Sternocostal head: sternum
- I: bicipital groove
- N: pectoral nerves
- A: arm adduction + IR

Pec Minor
- O: ribs 3-5
- I: coracoid process of scapula
- N: pectoral nerves
- A: scapula protraction, depression + stabilisation against tx cage

Palpation:
- Major: supine, arm 90 abduction, resisted horizontal flexion
- Minor: seated, HBB and lift off (palpate coracoid)

Question 5

Rhomboids Major and Minor

Answer 5

O: Nuchal Ligament + SPs C7-T1 (Minor) and SPs T2-5 (Major)
I: medial boarder scapula
N: dorsal scapula nerve
A: Scapula retraction

Palpation:
- Seated or prone, HBB and lift off

Question 6

Teres Major

Answer 6

O: inferior angle scapula
I: bicipital groove
N: subscapular nerve
A: arm adduction + IR

Palpation:
- Prone, arm 90 abduction, hanging off bed
- resist IR (push against therapist leg) - palpate from inferior angle until it disappears under post deltoids

Question 7

Infraspinatus

Answer 7

O: infraspinous fossa
I: GT humerus
N: suprascapular nerve
A: arm ER + stabilisation of humeral head in fossa

Palpation:
- Prone, arm 90 abduction, hanging off bed
- Ask patient to actively ER

Question 8

Trapezius

Answer 8

O: nuchal ligament, SPs C7-T12
I: Bicipital groove
N: Accessory nerve (CN XI)
A: elevation, retraction + depression of scapula

Palpation:
- Seated
- Upper fibres: shoulder shrug
- Middle fibres: HBB / retraction
- Inferior fibres: pull shoulders down

Question 8

Teres Minor

Answer 8

O: lateral boarder scapula
I: GT humerus
N: Axillary nerve
A: arm ER

Palpation:
- Prone, arm 90 abduction, hanging off table
- Resist ER, palpate just superior to teres major

Question 8

Latissimus Dorsi

Answer 8

O: Tx vertebra, thoracolumbar fasica, iliac crest + inferior 3-4 ribs
I: bicipital groove
N: Thoracodorsal nerve
A: Arm extension, adduction + IR

Palpation:
- Prone, arm 90 abduction hanging off bed
- Try to extend arm into therapist leg (swimming action)
- ** Palpate DISTALLY (towards pelvic attachment) as it is more superficial

Question 9

Shoulder AROM

Answer 9

“Do you have pain at rest?”
P1 and P2
R1 and R2
Goniometry
OP if no pain at end range or hx shoulder instability !

AROM:
- Flexion / extension
- Abduction / adduction
- IR/ER neutral and 90
- Horizontal flexion
- HBB (functional)

Question 10

Shoulder PROM

Answer 10

“Do you have pain at rest?”
P1 and P2
R1 and R2

PROM: Supine
- Flexion (short lever): elbow bent, on belly, support forearm
- Extension (elbow bent to remove passive biceps insufficiency!)
- Abduction
- IR / ER (neutral) - stride stance, stabilise humeral head lightly and rotate from wrist
- IR / ER (90 abduction) - supine, caution !!
- Horizontal flexion (from elbow)
- Horizontal extension (shuffle patient towards edge of bed, horizontally extend off bed)
- HBB

Question 11

Shoulder Accessory Movements

Answer 11

• AC Joint Inferior glide
• AP glide humeral head (neutral and 90)
• Humeral inferior traction (neutral and 90)

Question 12

MMT Shoulder Strength

Answer 12

• bilateral
• standing for flexion, extension, abduction, ER / IR (elbow bent)

Question 13

MMT Length - Pectoralis Group

Answer 13

Pectoralis Major = Adduction and IR

Pectoralis Minor = Scapula protraction, downward rotation and stabilisation

MMT = supine, arm into abduction 130, horizontal extension and ER