Transcript Shoulder Evaluation

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Soft tissue palpation
Muscular anatomy
Evaluation
Special tests
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Sterno-Clavicular
(SC) ligament
Acromio-Clavicular
(AC) ligament
Coraco-Clavicular
(CC) ligament
CoracoAcromioclavicular
(CA) ligament
Glenohumeral joint
Subacromial bursa
Subdeltoid bursa
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Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Pectoralis major
Pectoralis minor
Scalenes
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Teres major
Latissimus dorsi
Serratus anterior
Biceps brachii
Triceps brachii
Rhomboid major &
minor
Deltoid
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O: Supraspinous fossa
I: Superior greater
trochanter
A:?
N: Suprascapular nerve
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O: Infraspinous fossa
I: Posterior greater
tubercle
A: ?
N: Suprascapular nerve
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O: Lateral scapula
I: Posterior greater
tubercle
A: ?
N: Axillary nerve
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O: Anterior surface of
scapula (subscapular
fossa)
I: Lesser tubercle of
humerus
A: ?
N: Subscapular
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O: Clavicle, sternum,
and ribs
I: Intertubercular
groove of humerus
A: Int. rot, horiz. add,
flex, add below 90,
abd above 90
N: pectoral
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O: Anterior surfaces of
ribs 3-5
I: Coracoid process
A: Abd, Down rot, dep
N: Medial pectoral
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O: Transverse processes of
C2-C7
I: First & second ribs
A: Rib elevation & head
rotation (same side)
I: Spinal nerves C3-C8
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O: Inferior 1/3 of
lateral border of
scapula
I: Medial
intertubercular
groove of humerus
A: Ext, add, IR
N: Lower subscapular
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O: Ilium, sacrum,
lumbar vertebrae,
and lower 6 thoracic
vertebrae
I: Anterior humerus
A: Add, in rot, ext
N: Thoracodorsal
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O: Ribs 1-9 on lateral
thorax
I: Medial border of
scapula
A: Abduction, up rot
I: Long thoracic nerve
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O: LH-Superior
glenoid ; SH-Coracoid
I: Radial tuberosity
A: Elbow flexion &
supination, shoulder
flexion
N: Musculocutaneous
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O: LoH- infraglenoid lip of
scapula; LaH- posterior
humerus; MH- medial
posterior humerus
I: Olecranon process
A: Elbow extension,
shoulder extension
N: Radial
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O: Spinous
processes of C5-T5
I: Medial border of
scapula
A: Adduction,
down rot, elev
N: Dorsal scapular
nerve
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O: Clavicle, acromion, &
scapular spine
I: Lateral humerus
A: flex, ext, in rot, ex
rot, add, abd, horiz add,
horiz abd (everything!)
N: Axillary
Passive/Active ROM (Shoulder):
1. Flexion
2. Extension
3. Abduction
4. Adduction
5. External rotation
6. Internal rotation
Passive/Active ROM (Scapula):
7. Elevation
8. Depression
9. Abduction (protraction)
10. Adduction (retraction)
11. Internal rotation
12. External rotation
13. Circumduction
14. Apley scratch test
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Fracture/sprain test (1)
Rotator cuff tests (6)
Glenohumeral instability tests (11)
Biceps tendon tests (6)
Impingement tests (3)
Thoracic outlet tests (4)
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The examiner palpates the patient’s clavicle and
manipulates it inferiorly, superiorly, medially, and
laterally
Pain or crepitus indicates a positive test for
possible clavicular fracture
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Patient begins by abducting both arms to 90
degrees
Examiner then pushes downward on both arms
with equal force
Test is positive for rotator cuff injury if patient
experiences pain or pt’s arm(s) can be pushed
down without springing back into position once
the examiner suddenly stops applying the
downward force
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Pt in standing, the examiner instructs pt to internally rotate the
shoulder and point the thumb toward the floor
Examiner then resists the pt’s movement into full abduction
Examiner should perform the test in four different planes
 Abduction between 0 and 45 degrees in front of the body =
supraspinatus
 Abduction/flexion greater than 45 degrees in front of the body but less
than 90 degrees = infraspinatus
 Shoulder flexion in the empty can position straight out in front of the
body = teres minor
 Test performed across the body = subscapularis
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Any pain or weakness in any of the movements is a positive test
for strain of the affected rotator cuff muscle(s).
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Pt in standing, the examiner instructs the pt to
externally rotate the shoulders and actively lift
both arms overhead
Test positive for rotator cuff strain if the pt notes
pain and/or is unable to perform the movement
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Pt begins standing with the arms abducted to 90
degrees and externally rotated, and the elbows flexed to
90 degrees
From this position, pt’s hands will remain in the frontal
plane, however, the palmar surface will be positioned
anteriorly and the hands will be held overhead
Examiner then uses both of his/her hands to forcefully
push the pt’s hands posteriorly while pt resists
Pain indicates a positive test for muscle strain to one or
more of the rotator cuff muscles
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The examiner prepositions the pt with dorsal
surface of pt’s hand over the lumbar spine (end
range shoulder internal rotation)
Examiner applies resistance as pt attempts to lift
the hand off the spine and push posteriorly
Weakness indicates a positive test for
subscapularis muscular injury
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Examiner stabilizes the pt’s involved upper arm and resists
active shoulder external rotation and/or abduction
Pt is asked to rate his/her pain
Obvious pain is a positive sign for rotator cuff tendon pathology
and/or subacromial bursitis
Examiner then applies a caudal pull to the upper arm, resulting
in a traction force at the glenohumeral joint
During the pull, pt is instructed to repeat the resisted active
shoulder external rotation and/or abduction
If pain was present when the test was performed with no pull,
reduced pain with a pull is indicative of subacromial bursitis,
while no change or increased pain is indicative of rotator cuff
pathology.