Exam/Practical 1 - Shoulder pt. 1

what does this stand for: A-C

acromial-clavicular

what does this stand for: G-H

gleno-humeral

what does this stand for: S-T

scapulo-thoracic

what does this stand for: St-Cl

sternal-clavicular

what does this stand for: St-Co

sterno-costal

what are some things to look for during visualization of the shoulder

scapula distance from spine

scapular winging

squared off

step defect

sulcus sign

how should a normal shoulder appear

smooth, rounded, clavicles same height

how far should the scapula be from the spine

3 of the patient's fingers

a step defect is associated with what

A-C separation (Clavicle separates from scapula but humerus stays in place)

Squared off sign is associated with what

anterior shoulder dislocation (head of humerus is almost into chest cavity area/very midline from where it should be)

what is the most common position for an anterior G-H dislocation? What are the other positions

subcoracoid

subglenoid, subclavicular

sulcus sign is associated with what

G-H I (shoulder simply pulled down from joint)

where do patients feel pain for scapula

subscapularis at the anterior aspect

after visualization and static palpation, where do you move next

ROM - active then passive

what are the different movements to perform to assess ROM

flexion

extension

abduction

adduction

internal rotation

external rotation

apley's scratch

what is the average scapulo-humeral ration? what does this mean?

2:1 (humerus to scap)

- humerus moves roughly 120 degrees of abduction

- scapula moves the other 60 degrees

the first 90-120 degrees of abduction comes from the ___

G-H joint

if the scapula begins moving in after 30 degrees of abduction, how does the ration change

1:1 (humerus has lost some function)

if we noted a 4:1 S-H Ratio, what does this mean

the scapula has lost function

dysfunction of which joints may lead to decreased scapular function

S-T

St-Cl

A-C

what are the different orthopedic tests you can use for the shoulder

Apley's Scratch

Apprehension

Dawburn's

Drop Arm

Dugas

Yergason's

during Apley's, when does adduction/flexion occur

reaching in front of neck to reach behind the back

during Apley's, when does external rotation, abduction, and flexion occur

reaching over the head to touch opposite scapula

during Apley's, when does internal rotation and extension occur

reaching behind back to touch opposite scap

if the external rotation part of Apley's is decreased, what could this mean

G-H I (humerus has gone inferior)

if the internal rotation part of Apley's is decreased what could this mean

S-T L (scapula is lateral)

G-H P (humerus is posterior)

how do you perform apprehension test

place patient shoulder into 90 degrees of abduction and external rotation, push P-A on the posterior humerus

what is Dawburn's used to test

subacromial bursitis

how do you test Dawbunrs

press into subacromial space, lift arm into abduction and slight flexion

what does a positive dugas test indicate

anterior shoulder dislocation

what does a positive yergason's test indicate

transverse humeral ligament laxity or bicipital tendonitis

during the drop arm test, if part 1 is positive it means there is a grade ___ tear. If part 2 is positive, there is a grade __ tear. If part 3 is positive, there is a grade ___ tear. If it is positive on the first few degrees of abduction, there is a ___ tear

3, 2, 1

supraspinatus

what is part one of the drop arm test

patient raises arm against gravity

what is part 2 of drop arm test

patient slowly lowers arm against resistance

what is part 3 of drop arm test

patient holds arm against object to set up reflex with rotator cuff muscles

what muscle test is used for St-Cl and St-Co joints

pectoralis

- patient supine, arm perpendicular to floor with thumb towards feet

what is the direction of movement for the muscle test of a St-Cl joint

towards the clavicle (45 degree angle)

what is the direction of movement for the muscle test of a St-Co joint

towards the sternum (horizontal across body)

if the pec major test is weak at the sternal attachment, what could the listings be

st-co I or St-Co S

if the pec major test is weak at the clavicular attachment, what could the listing be

st-cl S

what muscle test is used for a G-H I

anterior deltoid

- supine, arm parallel to floor with palm down

what muscle test is used for G-H P

teres major

- supine, hand under low back, elbow parallel to floor

what muscle test is used for A-C joint

coracobrachialis

- arm flexed with hand by ear, doctor pulls bicep

if the coracobrachialis muscle test is weak AND the clavicle moves DOWNWARD, then the muscle is intact and there is a possible listing of ____

A-C PS

if the coracobrachialis muscle test is weak AND the clavicle does NOT move downward, then there is a ___ of the A-C joint

tear

how do you assess fluid motion of the St-Cl joint

1. in front of patient

2. fingertips at st-cl joint

3. patient shrugs shoulders

4. patient shrugs, moves shoulders back, and puts them down

how do you assess fluid motion of the A-C joint

1. behind patient

2. have patient lean into your hand right below humeral head

3. stabilize scapula and press down on clavicle

how do you assess fluid motion of the G-H joint

1. behind patient

2. stablize scapula and clavicle

3. hand on elbow, slightly push up

how do you assess fluid motion of the S-T Lateral joint

1. side of patient

2. press shoulder down

3. push into the inferior lateral aspect of scapula

how do you assess fluid motion of the S-T Medial joint

1. side of patient

2. pull shoulder up

3. push into the inferior medial aspect of scapula

how do you assess fluid motion of the St-Co joint

1. in front of patient

2. fingertips in the intercostal space

3. take deep breath in and out