Shoulder: tests, muscles, etc Flashcards
(20 cards)
Describe the muscles involved in shoulder abduction
0-15 degrees = supraspinatus
after about 20 degrees = deltoid (until 90 degrees)
beyond 90 = trapezious (via “pulling”)
name 4 muscles of rotator cuff and their actions
1) Supraspinatus = initiates abduction!
2) Infraspinatus = external rotation (greater trochanter of humerus)
3) teres minor = also external rotation (greater trochanter)
4) Subscapularis = internal rotation (lesser trochanter)
What test would you use in suspected teres minor/infraspinatus tear?
external rotation test
What test would you use in suspected supraspinatus tear?
empty can test
What test would you use in suspected subscapularis tear?
internal rotation test
What is shoulder impingement?
Due to repeated overhead usage/abduction. Caused by supraspinatus being “impinged” between head of humerus and acromion… leads to supraspinatus weakness with overdominance of deltoid muscles
What are 2 tests for shoulder impingement?
1) Hawkins-Kennedy = arm forward and flexed at 90 (fist toward ceiling). Examiner will internally rotate the shoulder to butt the supraspinatus against the acromion (induce pain)
2) Neer Test = hold arm straight down by patients side, and examiner will passively bring the whole arm straight up to ear
What causes a winged scapula?
paralysis of serratus anterior innervated by the long thoracic nerve
What is the most common shoulder dislocation?
Anterior and inferior! (no muscles to prevent these movements out of the socket)
What is a “sulcus sign” of multidirectional glenohumeral instability?
When pulling down on the humerus causes more than 1 cm of inferior displacement (can be completely normal in young girls)
What is the rockwood glenohumeral apprehension test for anterior capsule instability?
abduction arm with elbow flexed at 90 (forearm horizontal and level with floor) and the forearm is externally rotated (fist to ceiling) with an anterior force on humerous
How do you most commonly get an acromio-clavicular sprain?
landing on the tip of the shoulder
What problem with the clavicle is an emergency?
posterior sternoclavicular displacement can press into vessels of neck and trachea (medical emergency!)
what is speeds test?
check for bicep tendonitis
Palms up with arms fully outstretched and have them flex at elbow with examiner resistance
What is a good test for suspected glenoid labrum tear?
O’briens SLAP test
How does I O’briens SLAP (superior labral tear from anterior to posterior = SLAP) test?
2 Parts:
Part 1: Hold arm straight out in front, 30 degrees adducted, and internal rotation of humerus (thumb to floor). Have patient resist your downward pressure
Part 2: With arm in same position, have them externally rotate humerus (palm to ceiling) and again have patient resist your downward pressure.
A positive test = a “deep shoulder” pain with internal rotation (thumbs down = painful) BUT not painful with external rotation (palms to ceiling)… This is indicative of glenoid labrum tear however…. A-C sprain could cause a false positive
What is a good test for AC Joint or labral tear?
Cross arm test. Fully outstretched arm is passively brought across body.
Pain “superficially” suggests AC sprain
Pain “deep” suggests labral tear
What is a common shoulder problem especially among elderly and diabetics?
adhesive capsulitis aka “frozen shoulder”… they will not be able to hold arm against body, it looks to be stuck abducted at 30 degrees
What is thoracic outlet syndrome?
Compression of vein, artery or nerve in shoulder that causes a cold, numb, tingly sensation with repeated overhead activity
What is apley scratch test?
One hand up over shoulder and touch shoulder blade with fingers = tests extension and internal rotation
Other arm folded behind back horizontal (military stance) = tests external rotation and flexion
If you have them try to do both at same time, then you’re testing 4 big movements at once (tell them to try to touch fingers)
