Clinical Examination

week 5: UQ assessment

Observation

skin changes, atrophy, posture

skin changes

Redness, swelling, surgical scars, cysts, masses

signs of atrophy

Nerve palsies, muscle lesions, more serious pathologies, SCM, Trapezius, Deltoid, Supraspinatus. Infraspinatus

posture in all planes

Excessive kyphosis, rounded shoulders, forward head posture, Scoliosis, shoulder elevation/depression

gross AROM movement Screen

assess combined functional movements, look for symmetry, look for limitation in movement/pain reproduction

functional shoulder AROM (Ext/IR)

functional shoulder AROM (ABD/ER)

UE bony palpation

spine, inferior angle, vertebral border, supraspinous & infraspinous fossa, acromion & coracoid process

Humeral palpation sites

1. lateral epicondyle

2. medial epicondlye

elbow palpation sites

olecranon process, radial head

Shoulder AROM Assessment

1. perform standing or sitting

2. look for patients willingness, pain, limitation in AROM

3. compare bilaterally

4. look for compensatory behavior

Shoulder AROM: flexion

patient/therapist: standing position

check goniometer position

compensation: shoulder hiking, momentum use, trunk extenion, ipsilateral cervical SB

Shoulder AROM: flexion values

0-180 degrees.

Shoulder AROM: Extension

patient/therapist: standing position

check goniometer position

compensation: momentum use, trunk extension

Shoulder AROM: extension values

0-60 degrees

Shoulder AROM: abduction

patient/therapist: standing position

check goniometer position

compensation: shoulder hiking, momentum, trunk side bending, ipsilateral cervical SB

Shoulder AROM: Abduction values

normal values: 0-180 degrees

internal rotation behind back

record spinous process level that teh patient can reach

internal rotation example

R shoulder IRBB: T7 SP

compensation for internal rotation

using momentum, forward trunk lean

external rotation

while keeping the elbow against teh body, externally rotate the shoulder

external rotation

lifting arm away from body, rotating body to the same side, extending the elbow

PROM assessment

1. supine/prone

2. therapist performs 100% of the movement, patient is relaxed

3. assess end-feel

4. assess integrity, compare bilaterally

PROM: Flexion value

normal ROM: 0-180

PROM: shoulder extension value

normal ROM: 0-60

PROM: shoulder abduction

normal: 0-180 degrees

PROM: Internal rotation values

0-70 degrees

internal rotation compensation

anterior migration of scapula when IR is maxed out

PROM: external rotation values

normal ROM 0-90 degrees

PROM external rotation compensation

anterior migration of humeral head when ER is maxed out

manual muscle testing

grading scale utilized to objectify strength

consistent instruction to patient

“hold this position. Don’t let me move you.”

Assess the uninvolved side first

lets you know the. patient’s “normal'“ ability to generate force

Patient postitioning

helps isolate the targeted muscles & helps to minimize compensatory movement

assess muscle in _____ position

midrange

stabilization

one hand stabilizes the patient while the other hand is sued to provide resistive force to the muscle

direction of force

force is applied in the opposite direction of the lie of pul of the muscle.

speed of force production

therapist resistive force should ramp up over the course of 1-2 seconds, be held 3-4 seconds, and ramp down 1-2 seconds

the MMT grading scale is scaled 0-5 and is

This method of assessing strength is still used widely across settings and is recognized by insurance companies as a way to document improvements in strength.

MMT grading scale: 0/5 - 2+/5

gravity minimized positions

MMT grading scale: 2+/5 - 5/5

against gravity positions

only objective strength grade is ____ because no external force is applied.

3/5

0/5

no palpable or observable muscle contraction

1/5 (trace)

no visible movement, palpable or observable tendon contraction

2/5 (poor)

able to move through full ROM gravity eliminated.

3/5 (fair)

hold test position against gravity

3+/5 (fair+)

hold test position against slight resistance

4-/5 (good-)

hold test position against slight to moderate pressure

4/5 (good)

hold test position against moderate resistance

5/5 (normal)

hold test position against maximal resistance