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Patient Management II > Shoulder Complex Evaluation > Flashcards

Shoulder Complex Evaluation Flashcards

1
Q

Red flags for shoulder complex in the history

A
  • no incident or accident
  • glove like numbness
  • are the symptoms constant/unrelenting
  • radiating symptoms across multiple dermatomes
  • sudden onset of severe pain
  • interrupting sleep/worse at night
  • symptoms are constant
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2
Q

Patient history that would make you think impingement

A
  • Stage 1: intermittent mild pain with overhead activities
  • Stage 2: mild to moderate pain with overhead activities
  • Stage 3: pain at rest or activities, night pain, & weakness
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3
Q

Patient history that would make you think rotator cuff tear (RCT)

A
  • night pain
  • weakness in abduction & external rotation
  • loss of AROM
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4
Q

Patient history that would make you think frozen shoulder

A
  • inability to perform ADLs due to loss of motion
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5
Q

Patient history that would make you think instability

A
  • apprehension with abduction & external rotation
  • popping
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6
Q

Patient history that would make you think labral tear

A
  • clonking with overhead motion
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7
Q

Patient history that would make you think AC separation or arthritis

A
  • localized pain
  • swelling/deformity over AC joint
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8
Q

Patient history that would make you think cervical spine

A
  • pain/numbness below elbow in dermatomal distribution
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9
Q

Self assessments for shoulder injuries

A
  • DASH (disabilities of the arm, shoulder, and hand)
  • Oxford shoulder score (catches the more active patient)
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10
Q

What might you see in a scapular assessment

A
  • bilateral with 1-3 lb weights to bring out impairments better
  • Normal
  • Subtle dyskinesia
  • Obvious dyskinesia
  • look for winging, hitching (on the way up one scapula stops & quickly catches up), & dumping (on the way down one scapula stops & quickly catches up)
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11
Q

Describe scapular reposition test (McClure)

A
  • manually reposition scapula with elevation
  • look for decreased pain, improved motion, or improved strength
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12
Q

Describe scapular assist test

A
  • assist with upward rotation through facilitation of lower trapezius (try to cue lower trap)
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13
Q

Describe scapular flip test

A
  • resist glenohumeral external rotation while feeling for medial scapular border to wing
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14
Q

Describe scapulohumeral rhythm

A
  • 0-30 degrees elevation is GH motion
  • 30-90 degrees elevation 2:1 ratio of GH movement (60 degrees & snap protraction and 30 degrees external rotation)
  • 90-170 degrees elevation is a 1:1 ratio
  • 170-180 degrees is TS extension
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15
Q

Common painful ranges

A
  • pain & limited between 70-110 degrees scaption: rotator cuff impingement, RCT, subacromial bursitis
  • painful arc between 70-110 degrees scaption with full ROM: subacromial bursitis, impingement
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16
Q

General guidelines for resisted movements

A
  • IR is stronger than ER 3:2 ratio
  • adduction is stronger than abduction 2:1 ratio
  • extension is stronger than flexion 5:4 ratio
  • increasing weakness with reps = cervical nerve injury
  • consistent weakness with reps = muscular
17
Q

Peripheral nerve tests

A
  • Spinal accessory nerve (SCM & upper traps): inability to abduct arm greater than 90 degrees
  • Musculocutaneous nerve (biceps, brachialis, & coracobrachialis): weak elbow flexion with forearm supination
  • Long thoracic nerve (serratus anterior): inability to flex fully extended arm (scapular winging)
  • Suprascapular nerve (supraspinatus & infraspinatus): pain with shoulder flexion and/or abduction
  • Axillary nerve (teres minor & deltoid): inability to abduct arm
18
Q

Open pack & closed pack position for shoulder joint mobilizations

A
  • Open pack: 55 degrees abduction with 30 degrees horizontal ABD & slight ER (scaption plane)
  • Closed pack: max abduction & ER
19
Q

What is the capsular pattern of the shoulder

A
  • more ER than ABD and more ABD than IR
  • ER > ABD > IR
20
Q

What motions do the different glenohumeral joint mobilizations improve

A
  • Lateral distraction: all motions
  • Inferior glide: abduction
  • Anterior glide: ER and horizontal abduction
  • Posterior glide: flexion and horizontal adduction
21
Q

What motions do the the different SC joint (sternoclavicular) mobilizations improve

A
  • Posterior glide: retraction
  • Anterior glide: protraction
  • Inferior glide: elevation
  • Superior glide: depression
22
Q

History for instability

A
  • multiple recurrent subluxations
  • injury to the shoulder
  • dislocation
  • sensation of something slipping/unstable or anxiety in certain positions
23
Q

Special tests for instability

A
  • Sulcus sign
  • Palpation of subacromial space
  • Load and shift
  • Apprehension/Relocation/Release
24
Q

History for labral tear

A
  • FOOSH
  • brace oneself with an outstretched arm in MVA
  • lifting heavy objects repeatedly
  • overhead activities
25
Q

Symptoms of a labral tear

A
  • popping, clicking, or catching in the shoulder
  • pain when you move your arm over your head or throw a ball
  • a feeling of weakness or instability in the shoulder
  • aching pain of vague location
26
Q

Special tests for labral tear

A
  • Anterior slide test
  • Crank test
  • Compression rotation test
  • Active compression test
  • Bicep load test
  • Kim test
27
Q

History & symptoms for subacromial impingement

A
  • overhead activities
  • difficulty reaching up behind the back
  • pain with overhead use of the arm
  • weakness of shoulder muscles
28
Q

Test item cluster for subacromial impingement

A
  • Hawkins and Kennedy impingement sign
  • Painful arc sign
  • Infraspinatus muscle test
29
Q

History and symptoms for rotator cuff pathology

A
  • age >40
  • overhead sports
  • overhead occupations
  • dull ache deep in the shoulder
  • disturb sleep, particularly win lay on affected side
  • painful to reach behind back
  • weakness
30
Q

Test item cluster for full thickness RCT (rotator cuff tear)

A
  • Drop arm test
  • Painful arc sign
  • Infraspinatus muscle test
31
Q

Special tests for supraspinatus tear

A
  • Drop arm test
  • Drop sign
  • Full can
  • Empty can
  • Scapular retraction test
  • ER lag sign
  • Subacromial grind test
32
Q

Special test for infraspinatus tear

A
  • Dropping sign
33
Q

Special test for teres minor tear

A
  • passively place patient in 90 degrees scaption and have them ER against resistance
  • Hornblowers
34
Q

Special tests for subscapularis tear

A
  • IR lag sign
  • Napoleon test
35
Q

History for AC joint separation

A
  • FOOSH
  • cradling arm decreases pain
  • pain directly over AC joint
  • horizontal adduction painful
  • positive active compression test
36
Q

3 types of AC joint separation

A
  • Type I: AC ligament disruption but coracoclavicular ligaments intact
  • Type II: AC joint ligaments torn and coraocclavicular ligaments disrupted
  • Type III: all ligaments torn and complete AC joint separation
37
Q

History for adhesive capsulitis (AKA frozen shoulder)

A
  • gradual onset of loss of ROM in a capsular pattern (ER>ABD>IR)
  • may be accompanied with a history of shoulder pain however generally idiopathic
  • pain with movement
  • pain when sleeping on involved side
  • difficulty with ADLs
  • Freezing, Frozen, and Thawing (18 months to 2 years for natural progression to self resolve)

Patient Management II (17 decks)

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