The Shoulder

Question 1

4 Joints of the shoulder

Answer 1

Glenohumeral, Acromioclavicular, Sternoclavicular, Scapulothoracic

Question 2

4 Muscles of the rotator cuff

Answer 2

Supraspinatus, infraspinatus, subscapularis, teres minor

Question 3

Observations

Answer 3

Scapular winging (serratus anterior)
Step deformity (acromioclavicular)
Sulcus sign (glenohumeral)

Question 4

Olecranon-Manubrium Percussion Test

Answer 4

How to perform: Tap olecranon with finger while using the stethoscope on the manubrium.
Positive: The sound is different on the affect vs. non-affected side. Indicates fracture or dislocation

Question 5

Capsular pattern: Restricted motion occurs in what order?

Answer 5

1. External rotation
2. Abduction
3. Flexion
4. Internal rotation

Question 6

Speed’s Test

Answer 6

How to perform: Elbow extended, forearm supinated, feel for bicipital groove as patient moves arm up and down against resistance.
Positive: pain/tenderness in bicipital groove
Testing for biceps tendonitis, tenosynovitis, tendonosis. Tear of the gleaned labrum

Question 7

Painful Arc

Answer 7

How to perform: abducting shoulder 60-120 degrees, if there is pain in this area there could be impingement and pain.
Testing for: supraspinatus muscle involvement in pain

Question 8

Codman’s Drop Arm test

Answer 8

How to perform: Passively elevate arm to 150 degrees, Ask patient to slowly lower it to one side once dropped.
Positive: Pain, weakness, or compensatory muscles activate. Arm drops quickly due to pain.
Test indicates possible tear in supraspinatus muscle.

Question 9

Empty Can test

Answer 9

How to perform: Arm out in front and 30 degrees to the side. Thumb down. Firm pressure applied down on patients arm and they resist.
Positive: Pain/weakness in subacromial region - could be rotator cuff syndrome or subacromial impingement.
Testing for supraspinatus muscle involvement

Question 10

Muscle test external rotation

Answer 10

Arms at 90 degrees bent, Patient attempts to externally rotate against resistance.
Testing for: infraspinatus and teres minor involvement

Question 11

Muscle test internal rotation

Answer 11

Arms bent at 90 degree and against resistance try to internally rotate.
Testing for subscapularis involvement

Question 12

Gerber Lift off test

Answer 12

Dorm of hand in small of back, life hand away, give resistance to see strength of subscapularis muscle.

Question 13

Rotator Cuff Tear Diagnostic Cluster

Answer 13

+Drop arm test
+Painful arc
+Infraspinatus strength test (external rotation)

Question 14

Diagnostic Test Cluster for Subacromial Impingement

Answer 14

+ Hawkin’s Kennedy Test
+ Painful arc
+ Infraspinatus strength test

Question 15

Hawkin’s Kennedy Test

Answer 15

How to perform: Patient seated or standing. Shoulder flexed to 90 and elbow flexed to 90. One hand stabilizes proximal to elbow the other hand holds proximal to wrist. Examiner quickly moves arm into internal rotation.
Positive: pain pinches supraspinatus tendon against coracoid process.
Testing for supraspinatus impingement or tendonosis.

Question 16

Neer Impingement Test

Answer 16

How to perform: Seated or standing, stabilize the scapula by keeping it depressed. Arm straight, Palm facing out and thumb down, lift arm passively to 180 degrees and back down. Do with both internal rotation and external rotation.
Positive: Pain near greater tuberosity or pinching against acromion.
Findings: With internal rotation: supraspinatus impingement
With External rotation: biceps impingement

Question 17

Acromioclavicular crossbody adduction and resisted extension test

Answer 17

Passive, active and resisted.
How to perform: Patient reaches across body to other shoulder. Examiner does it for the patient. The examiner resists the patients attempt to abduct the shoulder back to the starting place.
Positive: localized pain at the AC joint; OR localized pain at the SC joint.
May indicate dysfunction is whichever location is noted.

Question 18

Acromioclavicular Commpression test…AKA Obrien’s Test

Answer 18

How to perform: Part 1: Arm extended out, bring inward 10-15 degrees adduction, thumb down. Resistance applied to upward motion. Located where the pain is.
Part 2: Thumb up now, if pain disappears it is a labrum problem.
Positive: If labrum tear, patient will feel pain deep in the joint, may be pain or clicking, if pain is reduced in part 2.
If acromioclavicular joint sprain - positive will be superficial pain localized to AC joint.

Question 19

Shoulder Apprehension Test

Answer 19

How to perform: Patient standing, gently externally rotate the shoulder while pushing on the humeral head forward.
Positive: Apprehension

Question 20

Shoulder Passive compression test

Answer 20

How to perform: Patient lies on side - compress elbow up into glenoid fossa - hold patient there, externally rotate to end feel then move shoulder into flexion and extension.
Positive: Pain and/or clicking

Question 21

Modified Dynamic Labral Shear Test

Answer 21

How to perform: Patient standing, passive movement. Move arm into position of 30 degree forward, elbow 90 degrees. Lift 150 degrees overhead while externally rotating. lift arm up and down.
Positive: Pain
Test for Labral tears

Question 22

Passive Distraction Test

Answer 22

How to perform: Patient lying down supine, Arm off table. Lift arm out to side abducted to 150 degrees - palm at ceiling, hold onto humerus at shoulder. Don’t rotate the humerus! Forcibly rotate forearm into pronation and supination. This stretches the biceps tendon
Positive: Pain/clunking.