shoulder orthos Flashcards
(32 cards)
what are the best screens for shoulder pain?
- Apley’s scratch (ext rot C7; IR T7 use middle of hand)
- Wall angels (upper crossed syn)
Name the 5 tests to use for subacromial pain syndrome.
- Hawkins Kennedy (most sensitive)
- Painful Arc (most specific)
- Neers
- RSERT
- Empty can
How do you do the Hawkins Kennedy test?
Flex arm 90 then passively internally rotate shoulder.
+ve = pain : supraspinatus tendon pushes agst coracoacromial lig & coracoid process. Indicates supraspinatus tendinosis.
How do you do the painful arc?
abduction of the arm in the plane of the scapula.
+ve pain btn 60 - 120 (GH issue)
AC 160 - 180
How do you do the Neers test?
Passively and forcibly elevate arm in scapular plane with arm in IR/ER by examiner.
How do you do the RSERT?
Seated, shoulder abd 90, elbow flexed 90. Support wrist and elbow. Passively ER shoulder to end range using wrist. Ask patient to maintain when wrist is released.
+ve unable to hold, spings back
how do you perform the empty can test?
Arm abd 90. IR. stabilize at wrist. Apply downward pressure while patient resists.
+ve weakness or pain for supraspinatus tendonitis/tear
what are important factors when thinking about shoulders
female
not employed
high level of physical load - lifting, carrying, pushing/pulling
46 - 55yrs
episode of arm, neck, shoulder complaints in last 12 months.
Factors associated with negative prognosis for shoulders.
- pain > 3 mo
- high intensity of pian at presentation
- high rating of disability at presentation
- restricted ROM
- more complex presentation
- psychosocial factors
what muscles generate torque through the shoulders?
lat dorsi
deltoid
serratus anterior
pec major
what sports are associated with repetitive shoulder movements and are more likely to present?
swimming
volley ball
baseball
what muscles are associated with maintaining scapular motion?
traps (UT, LT, MT)
rhomboids
levator scap
pec minor
what are the co-morbidities for rotator cuff tears?
tennis elbow
carpal tunnel syndrome
trigger fingers
achillies tendonitis
oral steroids
diabetes milletus
what are the four tests for rotator cuff pathology?
empty can (supraspinatus)
full can (infraspinatus)
bear hug / belly press (subscapularis)
resisted ER in scapular plane (infraspinatus & teres minor)
how do you perform the supraspinatus test?
(empty can)
straight arms abducted 90 & IR (thumb down)
stabilise patients arms at wrist
put downward pressure while patient resists
+ve weakness or pain for supraspinatus tendonitis or tear
how do you perform the full can test?
thumbs pointing up
+ve weakness or pain in supraspinatus tendonitis /tear
how do you perform the belly press test?
what does it measure?
patient attempts to press hand agst abdomen (while moving elbow forward- chicken winging it) with resistence by examiner
subscapularis
how do you perform the bear hug test?
what does it measure?
place hand against alternative shoulder with hand open. Examiner pulls hand away. If weak or gives way = subscapularis weakness / tear
how do you perform the lift off test?
what does it measure?
place open hand in small of back.
lift away from back.
lift away from back with resistence from examiner
tests subscapularis
how do you perform resisted ER in scapular plane?
What does it measure?
standing sitting arm at side
elbow flexed 90 (thumb up)
apply IR force, patient resists.
+ve pain or inability to resist = infraspinatus strain
what are the tests to determine labral tears?
Compression rotation (grind test)
Obrien’s
Biceps load and shift I & II
Speeds
what are the most sensitive tests for labral tears?
- Compression rotation (aka grind test)
- anterior apprehension test
what is the most specific test for labral tears?
Biceps load and shift 1 & II
how do you perform the compression rotation test?
Patient supine
ABd shoulder 20 - 90 with elbow flexed 90.
apply axial compression through humerus while passively rotating humerus back and forth trying to trap labrum.
+ve: pain, clicking or catching sensation