Shoulder OP

Includes the following: Palpations of muscles and bones, OIA of muscles, Special tests, and the UQS

BONES

Clavicle (sternal end and acromial end)

Humerus (greater tuberosity, lesser tuberosity, bicipital groove, and deltoid tuberosity)

Scapula (inferior border, lateral border, vertebral/medial border, acromion process, coracoid process)

Biceps Brachii

A: flexion and aBduction

O: Short Head - coracoid process; Long Head - supraglenoid tubercle

I: radial tuberosity

Coracobrachialis

A: flexion and aDDuction

O: coracoid process

I: medial shaft of humerus

Anterior Deltoid

A: flexion, aBduction, horizontal aDDuction, and internal rotation

O: lateral 1/3 of clavicle

I: deltoid tuberosity

Middle Deltoid

A: flexion and aBduction

O: acromion process

I: deltoid tuberosity

Posterior Deltoid

A: extension, horizontal aBduction, aBduction, and external rotation

O: spine of scapula

I: deltoid tuberosity

Infraspinatus

A: external rotation, horizontal aBduction, and humeral head stability

O: infraspinous fossa of scapula

I: lateral portion of greater tuberosity of humerus

Subscapularis

A: internal rotation and humeral head stability

O: subscapular fossa (anterior surface) and axillary border of scapula

I: lesser tuberosity of humerus

Supraspinatus

A: aBduction, external rotation, and humeral head stability

O: supraspinous fossa (medial 2/3) of scapula

I: medial aspect of greater tuberosity

Teres Minor

A: external rotation and horizontal aBduction

O: lateral upper 2/3 of axillary border of scapula

I: lateral aspect of greater tuberosity

Teres Major

A: extension, internal rotation, and aDDuction

O: inferior angle of scapula

I: medial of bicipital groove

Triceps Brachii

A: extension and aDDuction

O: Long Head - infraglenoid tuberosity of scapula; Lateral Head - lateral and posterior surface of proximal ½ of humerus; Medial Head - distal 2/3 of medial and posterior humerus

I: olecranon process of ulna

Pectoralis Major

A: aDDuction, horizontal aDDuction, humeral flexion, internal rotation, and depression of shoulder girdle

O: medial ½ of clavicle and costal cartilage of ribs 6-7

I: greater tuberosity of humerus

Pectoralis Minor

A: scapular anterior tilt

O: costal cartilages of ribs 6-7 and anterior portion of ribs 3-5

I: spine of scapula

Upper Trapezius

A: scapular elevation and upward rotation, rotation of C-spine (to opposite side), and extension of C-spine

O: occiput and spinous process of C7

I: lateral 1/3 of clavicle, acromion process, and scapular spine

Middle Trapezius

A: scapular retraction

O: spinous processes of C7 and T1-T5

I: acromion process and spine of scapula

Lower Trapezius

A: scapular depression

O: spinous processes of T8-T12

I: spine of scapula

Latissimus Dorsi

A: extension, internal rotation, aDDuction, and depression of shoulder girdle

O: spinous processes of T6-L5 and posterior iliac crest

I: bicipital groove of humerus

Levator Scapulae

A: scapular elevation and downward rotation

O: transverse processes of C1-C4

I: superior medial angle of scapula

Serratus Anterior

A: scapular upward rotation and protraction, scapular depression, and scapular elevation

O: anterior portion of ribs 1-8 or 9th

I: superior, vertebral, and inferior angles of scapula

Rhomboid Major

A: scapular retraction, scapular elevation, and scapular downward rotation

O: spinous processes of T2-T5

I: vertebral border of scapula

Rhomboid Minor

A: scapular retraction and scapular elevation

O: spinous processes of C7-T1

I: vertebral border of scapula

ROM

Flexion: 180

Extension: 50

ADDuction: 40

ABduction: 180

Internal Rotation: 90

External Rotation: 90

Apely’s Scratch Test

Test For: motion available to the shoulder complex (AROM)

Patient Position: Standing or short-sitting

Instructions: Patient will (1) touch the opposite shoulder (IR and ADD), (2) reach behind their head and touch their shoulder from behind (ER and ABD), (3) reach behind the back and touch scapula (IR and ADD)

Positive (+) Test: If the patient has pain in position, cannot move to position, or maintain the position

AC Traction Test

Test For: AC sprain/injury

Patient Position: Short-sitting. Patient’s arm is positioned to their side.

Clinician Position: Examiner stands to the side, grasps the patient’s arm with one hand and places their other hand on top the shoulder medial to the AC joint.

Instructions: Examiner pulls down on the patient’s arm.

Positive (+) Test: The space between the acromion and clavicle increase, scapula moves away from the acromion.

AC Compression (Shear) Test

Test For: AC ligament injury

Patient Position: Patient stands with arm at their side

Clinician Position: Standing on affected side

Instructions: (1) Examiner aBducts the shoulder to 90 degrees, then horizontal flexes the arm. (2) Examiner places hands on either side of AC joint, examiner then compresses the AC joint between their hands.

Positive (+) Test: pain in AC joint

Painful Arc Test

Test For: Rotator Cuff Pathology or Subacromial Impingement Syndrome

Patient Position: Standing

Instructions: Patient will actively elevate their arm (aBduction) in the plane of the scapula through complete ROM. Have patient rate their pain from 0-10, tells us if they feel pain, and where.

Positive (+) Test: If subject complains of pain in the 60-120 degrees arc of motion

Arm Drop

Test For: Patient’s ability to control humeral motion or Rotator Cuff Pathology

Patient Position: Standing

Clinician Position: Stand on the affected side

Instructions: Examiner passively moves subject’s arm to 90 degrees of elevation with neutral rotation and full elbow extension. Tell patient to hold their arm in this position. Examiner releases arm and observes.

Positive (+) Test: If the patient is unable to maintain the elevated position and the arm drops to a lower positon.

Empty Can (Jobe) Test

Test For: Subacromial Impingement/Rotator Cuff Pathology

Patient Position: Standing or sitting

Clinician Position: Standing on the affected side

Instructions: Examiner passively aBducts the patient arm to 90 degrees and rotates the shoulder into internal rotation, the patient is instructed to aBduct their arm (push toward ceiling). Apply resistance at the patient’s elbow or wrist.

Positive (+) Test: If patient reports of anterior/superior pain or weakness during the test.

Lag Sign

Test For: Rotator Cuff Pathology

Patient Position: Sitting

Clinician Position: Standing on the affected side

Instructions: Examiner supports the upper arm with one hand at the elbow and holds proximal to the wrist with the other. Examiner passively moves subject’s arm to 90 of elbow flexion, 20 degrees shoulder aBduction, and maximal external rotation. Patient needs to hold this position. Examiners releases wrist

Positive (+) Test: If the patient cannot hold the arm in the externally rotated position, and it lags into internal rotation

Neer Test

Test For: SAIS/Rotator Cuff Pathology

Patient Position: Sitting

Clinician Position: Standing on affected side

Instructions: Standing to the side of the upper extremity to be tested, hold the upper extremity at the elbow with one hand while stabilizing the scapula with the other hand. Internally rotate the shoulder and flex the shoulder into maximal forward flexion, keeping the elbow extended. If subject has pain, have him or her rate this pain.

Positive (+) Test: Pain in anterior-superior shoulder

Kennedy Hawkins Test

Test For: SAIS/Rotator Cuff Pathology

Patient Position: Sitting

Clinician Position: Standing on affected side

Instructions: Standing to the side of the upper extremity to be tested, bring the patient into 90° of shoulder and elbow flexion. Holding his/her wrist in one hand and supporting the distal humerus with the other hand, forcibly IR the humerus. If subject has pain, have him or her rate this pain.

Positive Tests: Pain in the anterior-superior shoulder

Scapular Assistance Test

Test For: Rotator Cuff Pathology/Poor Scapular Function

Patient Position: Standing in perfect posture and anatomical position

Clinician Position: Standing on affected side

Instructions: Keep your elbow straight, wrist neutral and lift your arm forward and toward the ceiling as far as possible. Examiner places one hand on the superior aspect of the scapula and the other on the inferior angle to assist the scapula into upward rotation with posterior tilt during active arm elevation. Record the location and rating of pain. Repeat this sequence with shoulder abduction.

Positive Test: There is decrease in pain by 2 or more points on a 0-10 pain rating scale compared to unassisted arm elevation

Scapular Reposition Test