Flashcards in Shoulder Examination Deck (67):
What are the first things you should do in an examination?
-Confirm patient details
-Explain procedure and gain consent
How should the patient be exposed?
Appropriately, exposing the shoulders.
How should the patient be positioned?
What should we ask before starting (after full consent etc)?
If the patient currently has any pain.
What is the first step of the actual examination?
Where do you inspect the patient from?
Anteriorly, laterally, and posteriorly
What should be looked for on the skin?
Scars from surgery or trauma
What should we look for in the shoulder girdle anteriorly?
What may asymmetry in the shoulder girdle indicate?
What should be looked for around the joints?
What might swelling indicate? (3)
Inflammatory joint disease
What should be looked for in the muscles anteriorly?
The bulk - wasting may be observed.
What might be the case if the deltoid on one side is wasted?
Axillary nerve injury
What should be looked for laterally?
What should be looked for posteriorly in terms of shape?
Asymmetry or deformity
What might posterior asymmetry or deformity indicate?
Which nerve would cause winging of the scapula?
Long thoracic nerve
Posteriorly, which muscles should be assessed for their bulk?
Which 3 other muscle groups should be assessed posteriorly?
The paravertebral muscles
Supraspinatus fossa muscles
Infraspinatus fossa muscle
What should step 2 be, after LOOK?
What should be felt on palpation?
Temperature across the joint
Which joints should be palpated?
Which bone should be palpated?
Which bony landmarks should be palpated?
Head of the humerus
Greater tuberosity of the humerus
Spine of the scapula
Borders of the scapula
How should this palpation be done?
Comparing each side to the other i.e. similtaneously
What is the 3rd step after LOOK and FEEL?
What are the 2 components of MOVE?
Passive and active movements
What movements can be used to screen for shoulder problems?
Ask the patient to put their hands behind their head, and then put their hands as far up their back as possible (like doing the clasp on a bra)
What does putting hands behind head test?
Abduction and external rotation
What does putting hands as far up back as possible test?
What 5 movements should be tested?
How is flexion tested?
Ask the patient to raise their arms upwards above their head
What angle range is normal for shoulder flexion?
How is extension tested?
Ask the paient to keep arms straight and stretch out behind them
What angle is normal for shoulder extension?
How is abduction tested?
Ask the patient to raise their arms sideways from their sides as far as possible
What angle range is normal for shoulder abduction?
Up to 180
How is adduction tested?
Ask the patient to bring their arms straight across their trunk
What angle range is normal for shoulder adduction?
How external rotation tested?
Ask the patient to flex their elbows to 90 degrees, then rotate arm outwards in an arc
What angle range is normal for shoulder rotation?
How is internal rotation tested?
Putting hands as far up their back as possible
Which bone should be individually assessed?
How should the scapula be felt?
Palpate inferior pole as the patient abducts the shoulder
What should the scapula be assessed for?
Degree and smoothness of movement
What should be felt at the shoulder when moving it?
If there is any crepitus
How should passive movements be done?
Ask pt to relax their arm fully and move their arm for them, all the movements listed above.
What special tests can be done?
The painful arc
External rotation aginst resistance
External rotation in abduction
Internal rotation against resistance
What does Jobe's test test?
The function of supraspinatus
How is Jobe's test carried out?
Abduct the arm to 90 degrees, then bring forward to about 30 degrees (iine with the scapula). Then internally rotate to point thumb at the floor. Push on arm and patient tries to resist. Do on both arms.
What can weakness in Jobe's test indicate?
A tear in supraspinatus
What may pain in Jobe's test indicate?
What does the painful arc test?
impingement of supraspinatus
How is the painful arc test performed?
Passively abduct arm to maximum point, then ask patient to lower it slowly themselves
Where does impingement of supraspinatus usually cause pain?
Between 60-120 degrees abducion
Should the painful arc test be used diagnostically?
No, not on its own, as it is not specific.
What does external rotation against resistance test?
Infraspinatus muscle function
How should the arm be positioned when testing external rotation against resistance?
Elbow flexed to 90 degrees, arm slightly abducted
Why does the arm need to be slightly abducted when testing external rotation against resistance?
To test external rotation against gravity
What may pain on external rotation against resistance indicate?
What may loss of power on external rotation against resistance indicate?
Infraspinatus tendon tear or muscle wasting
What test assesses the function of teres minor?
External rotation in abduction
How is the arm positioned in external rotation with abduction?
The arm adbucted to 90 degrees, and elbow bent to 90 degrees, then passively externally rotate
What does internal rotation against resistance test?
Subscapularis muscle function
How is internal rotation against resistance tested?
Pt places dorsum of hand on lower back. Apply light resistance and ask the pt to move the hand off their back
What does inability to internally rotate against resistance suggest?
Tendonitis or tear of the subscapularis muscle