Shoulder lab

Question 1

What special tests happen during AROM?

Answer 1

Painful arc sign

scapular dyskinesis test

Question 2

painful arc sign implies _________

pain between __________ degrees

Answer 2

impingement or RC pathology

60-120 degrees

Question 3

How do we overpressure IR and ER?

Answer 3

Hand on hip/stomach with elbow bent and overpressure at elbow while keeping hand still

Question 4

if we find a deficit in AROM, what do we do next

Answer 4

measure AROM and check passive aswell

Question 5

What are the 4 measurements we take for all shoulders

Answer 5

Flex, ABD, IR, ER

if they have pain with specific movement we might measure that too (Ext or horizontal add or abd)

Question 6

How to perform scapular dyskinesis test?

Answer 6

Have them elevate both arms at same time, if you have to squint it’s not there!

Obvious or normal

need 10+ reps and might need to add weight (3-5lbs)

Question 7

What is the SICK scapula sign?

Answer 7

Malposition of (S)capula

(I)nferior medial border

(c)oracoid w/ pain and malposition

scapular dis(k)inesia

Question 8

Limits in AROM but not PROM suggests what

Answer 8

muscular involvement

Question 9

If there is a deficit but AROM = PROM, what could this mean

Answer 9

capsular involvement

Question 10

how much ROM is needed for brushing hair

Answer 10

30-70 degrees horiz-add

105-120 abd

90 ER

Question 11

an inferior glide of the GH is for what?

A posterior glide is for what?

Answer 11

Abduction

Flexion, IR

Question 12

the elbow needs to be in what position relative to the body to perform GH joint play

Answer 12

above the body

Question 13

In what 2 scenarios will you assess AC jointplay

Answer 13

Pain at end of shoulder elevation

or

pain at AC joint

(Don’t assess if person cannot get their arm to end of shoulder elevation in first place)

Question 14

When should we check sternoclavicular joint play

Answer 14

if there’s pain in that region

Question 15

When should we assess scapulo-thoracic joint play?

Answer 15

Posterior shoulder pain, they’ve been immobile in a sling, or they had scapular dyskinesis

note: no capsule here to test

Question 16

Neer’s test tests for what?

what are the 2 arm positions in this test?

What is a positive sign?

Answer 16

impingement

ER + forceful elevation

followed by

IR with forceful elevation

Positive sign if less pain with ER

Question 17

Neers test specifically indicates an overuse injury to what 2 possible structures

Answer 17

supraspinatus tendon

or

biceps tendon

Question 18

how do you perform the hawkins kennedy test

what position do you start in

what does a positive test mean

Answer 18

Abd arm to 90 degrees with elbow bent, forcibly IR the shoulder, test in different degrees of horizontal adduction

start with arm by side and work your way to arm in front of body

positive test indicates supraspinatus tendinopathy

Question 19

how do you perform the cross body adduction test?

what are the 2 possible positive signs?

Answer 19

Pt elevates arm to 90 degrees, examiner forcefully horizontally adducts arm to end range

pain at subacromial space = impingement
pain at AC joint = AC joint pathology

Question 20

How do you perform speeds test?

What muscle is it testing?

positive test is what?

Answer 20

Examiner resists forward shoulder flexion w/ pt elbow fully extended and forearm supinated

biceps long head tendon

increased tenderness at bicipital groove = biceps tendinopathy

Question 21

If a special test for the shoulder includes weakness as a positive condition, what must you do?

Answer 21

compare both sides

Question 22

For what special tests must you test both sides

Answer 22

empty can test

full can test

infraspinatus test

Belly press test

Question 23

Which would you do first: empty can test or full can test?

Answer 23

Full can test before empty can test

Question 24

how to perform the full can test?

Answer 24

break test from this position (shoulder ER)

weakness or pain reproduced could indicate supraspinatus tendinopathy

Question 25

how to perform the empty can test?

Answer 25

break test from this position (shoulder IR) weakness or pain reproduced could indicate tendinopathy

Question 26

What tests are for muscle TEARS?

Answer 26

ER lag sign IR lag sign Drop arm test

Question 27

how to perform the infraspinatus test?

Answer 27

bring arm out to 45 degrees in scapular plane, maintain ER against resistance positive test = cannot hold against ER d/t pain or weakness infraspinatus tendinopathy

Question 28

how to perform the ER lag sign?

Answer 28

same position as infraspinatus test (out at 45 degrees in scapular plane) Pt is asked to hold position and examiner releases wrist if pt arm drops and cannot resist gravity = infraspinatus tear

Question 29

What muscle is the belly press test for? how to preform?

Answer 29

subscapularis Pt puts hand on belly, you try to pull hand away from belly positive test = any compensatory movement or unable to keep hand there infraspinatus tear/tendinopathy

Question 30

how to preform the lift off test? What muscle is it for?

Answer 30

For subscap Pt attempts to lift hand off from behind back and resist manual resistance unable = subscap pathology note: invalid test if pt cannot get to position (do belly press test instead)

Question 31

how to preform the IR lag sign test?

Answer 31

Same as lift off test but there is no manual resistance, they just have to hold the position inability to do so= subscap tear

Question 32

What test is for detecting large to massive RTC tears?

Answer 32

Drop arm test

Question 33

How to preform drop arm test What is the correct shoulder position?

Answer 33

Arm is passively placed in 90 degrees of ABD w/ elbow straight and shoulder ER Pt must hold arm in that position unable = large/massive RTC tear

Question 34

how do you preform the apprehension test? What is considered a positive test

Answer 34

Place pt with arm in 90 of abduction and max ER examiner applies Overpressure in ER while stabilizing the elbow (+) will have apprehension indicating anterior GH instability

Question 35

what is NOT considered a positive apprehension test

Answer 35

if the pt only has pain in the test position

Question 36

The sulcus sign implies what kind of instability

Answer 36

multidirection or inferior instability of the GH

Question 37

how do you test for the sulcus sign?

Answer 37

20-50 degrees of abduction and then apply downward traction depression greater than 1 finger is positive b/t humeral head and acromion

Question 38

How do you test a patient for posterior GH joint instability

Answer 38

posterior apprehension flex arm to 90 then horizontally adduct and apply posterior force positive if apprehension

Question 39

How to preform an obrien test? What is it for?

Answer 39

extend arm to shoulder height and fully IR, apply force then do same with ER positive test if more pain with IR than ER SLAP lesion

Question 40

how to preform a biceps load test? What is it for?

Answer 40

Bring arm to 90 elevation, ER, and elbow flexion. for Biceps load test 1 and resist at forearm. Positive if shoulder pain Bring arm to 120 for Biceps load test 2 (preferred test) positive if shoulder pain SLAP lesion

Question 41

If other instability tests are negative, what test can find old labral tears?

Answer 41

Clunk test

Question 42

What is considered a positive scapular assistance test?

Answer 42

if decreased shoulder symptoms happen when you assist upward rotation of scap

Question 43

how to preform the wall/floor pushup test?

Answer 43

Pt preforms 3-5 pushups and note any scapular weakness

Question 44

What is a considered a positive pec minor tightness test

Answer 44

Difference in shoulder height/acromion from table

Question 45

What 2 tests also work for AC joint pain? What are the tests unique to AC joint?

Answer 45

Obrien's (for SLAP) and Cross body abduction (for impingement) positive if pain at AC joint Palpation of AC joint, positive if pain look for step deformity, if present it indicates separation