Shoulder examination Flashcards
(36 cards)
What are the aspects of a comprehensive history you need to cover?
Presenting complaint History of presenting complaint i.e. SOCRATESIA Med/surg/medications/Allergies Family history Smoking/Diet/Alcohol/Exercise/Nutrition Occupation Relationship Preventative health i.e. vaccines, pap smears, cancer checks
From which angles should you examine the shoulder?
Anteriorly, laterally, posteriorly and in the axilla
How should a patient be positioned for a shoulder exam?
Standing in a neutral position
What should you look for generally in a shoulder exam patient?
Distress
Posture
Use of aids
Assymetry
What should you look for on close examination of a shoulder?
Deformity/asymmetry
Swelling - presence/where it’s located, if it’s diffuse or localised
Skin changes - scars/erythema
Muscle wasting in the deltoid and scapular muscles
What is the “feel” pathway in a shoulder examination?
Sternoclavicular joint Along clavicle, medially to laterally Acromioclavicular joint Acromion Subacromial space Greater tuberosity of the humerus Biceps tendon Scapular spine
Where is the biceps tendon?
Anterior to the greater tuberosity, sitting between the greater T and the lesser T
What does active movement by the patient reveal?
Bone, joint, muscle and nerve problems
What does passive movement reveal?
If normal on passive movement, but abnormal active movement, it suggests muscle or nerve problems
What should you describe to an examiner when moving the patient?
Range of movement
Presence of pain
Presence of crepitus
What are the six movements of the shoulder?
Flexion - arm straight
Extension - arm backwards and straight
Abduction - arms out to the siders, straight
Adduction - arms across the body, arms straight
External rotation - arms 90 degrees, elbows fixed in
Internal rotation - arms 90 degrees, elbows fixed in
Why do you have the elbow at 90 degrees for internal and external rotation?
To avoid pronation and supination of the forearm giving a false impression of glenohumeral rotation
Which muscles does abduction test? What is the degree of movement?
Tests the middle deltoid, and supraspinatus although the last 60 degrees involves scapulothoracic movement –> trapezius, serratus anterior
Which muscles does adduction test? What is the degree of movement?
Pectoralis major
Latissimus dorsi
50 degrees of movement
Which muscles does flexion test? What is the degree of movement?
Anterior deltoid
Clavicular head pectoralis major
180 degrees
Which muscles does extension test? What is the degree of movement?
Latissimus dorsi
Posterior deltoid
Sternocostal head pectoralis major
Which muscles does internal rotation test? What is the degree of movement?
Pectoralis major Latissimus dorsi Subscapularis Teres major Anterior deltoid 90 degrees
Which muscles does external rotation test? What is the degree of movement?
Infraspinatus
Posterior deltoid
Teres minor
65 degrees
What should you still check for if active movement is fine?
Crepitus
How do you check for crepitus?
Cup the shoulder with the top of your hand and gently abduct the arm
How should you present your findings?
Describe: Range of movement Presence of pain and when it occurred State findings on both sides i.e. Full range of pain free flexion to 180 degrees bilaterally
What do special power tests check for?
Integrity of tendon and muscle
Pain alone suggests tendon’s intact but inflamed
Pain and weakness suggests a tendon tear
Which special test assesses the supraspinatus? Describe it
Empty can test
Arm abducted to 90 degrees, with 30 degrees of forward flexion
Internally rotate hand so thumb points to the ground
Maintain that position while you apply resistance downwards
What does pain in the empty can test suggest?
Impingement/tendonitis
