Soft tissue palpation Muscular anatomy Evaluation Special tests.
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Transcript of Soft tissue palpation Muscular anatomy Evaluation Special tests.
SHOULDER EVALUATION
Overview Soft tissue palpation Muscular anatomy Evaluation Special tests
Soft Tissue Palpation
Sterno-Clavicular (SC) ligament
Acromio-Clavicular (AC) ligament
Coraco-Clavicular (CC) ligament
Coraco-Acromioclavicular (CA) ligament
Glenohumeral joint Subacromial bursa Subdeltoid bursa
Muscular Anatomy Supraspinatus Infraspinatus Teres minor Subscapularis Pectoralis major Pectoralis minor Scalenes
Teres major Latissimus dorsi Serratus anterior Biceps brachii Triceps brachii Rhomboid major &
minor Deltoid
Intrinsic Musculature: Supraspinatus
O: Supraspinous fossa
I: Superior greater trochanter
A:? N: Suprascapular
nerve
Intrinsic Musculature: Infraspinatus
O: Infraspinous fossa
I: Posterior greater tubercle
A: ? N: Suprascapular
nerve
Intrinsic Musculature: Teres Minor
O: Lateral scapula I: Posterior greater
tubercle A: ? N: Axillary nerve
Intrinsic Musculature: Subscapularis
O: Anterior surface of scapula (subscapular fossa)
I: Lesser tubercle of humerus
A: ? N: Subscapular
Pectoralis Major O: Clavicle,
sternum, and ribs I: Intertubercular
groove of humerus
A: Int. rot, horiz. add, flex, add below 90, abd above 90
N: pectoral
Pectoralis Minor O: Anterior
surfaces of ribs 3-5
I: Coracoid process
A: Abd, Down rot, dep
N: Medial pectoral
Scalenes O: Transverse
processes of C2-C7 I: First & second ribs A: Rib elevation &
head rotation (same side)
I: Spinal nerves C3-C8
Teres Major O: Inferior 1/3 of
lateral border of scapula
I: Medial intertubercular groove of humerus
A: Ext, add, IR N: Lower
subscapular
Latissimus Dorsi
O: Ilium, sacrum, lumbar vertebrae, and lower 6 thoracic vertebrae
I: Anterior humerus
A: Add, in rot, ext N: Thoracodorsal
Serratus Anterior O: Ribs 1-9 on
lateral thorax I: Medial border of
scapula A: Abduction, up rot I: Long thoracic
nerve
Biceps Brachii O: LH-Superior
glenoid ; SH-Coracoid
I: Radial tuberosity
A: Elbow flexion & supination, shoulder flexion
N: Musculocutaneous
Triceps Brachii O: LoH- infraglenoid
lip of scapula; LaH- posterior humerus; MH- medial posterior humerus
I: Olecranon process A: Elbow extension,
shoulder extension N: Radial
Rhomboids O: Spinous
processes of C5-T5
I: Medial border of scapula
A: Adduction, down rot, elev
N: Dorsal scapular nerve
Deltoid O: Clavicle,
acromion, & scapular spine
I: Lateral humerus A: flex, ext, in rot,
ex rot, add, abd, horiz add, horiz abd (everything!)
N: Axillary
EvaluationPassive/Active ROM (Shoulder): 1. Flexion 2. Extension 3. Abduction 4. Adduction 5. External rotation 6. Internal rotation
EvaluationPassive/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
Special Tests (31) Fracture/sprain test (1) Rotator cuff tests (6) Glenohumeral instability tests (11) Biceps tendon tests (6) Impingement tests (3) Thoracic outlet tests (4)
AC-SC Stress Test (fracture/sprain) 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
Drop Arm Test (rotator cuff): 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
Empty Can Test (rotator cuff): 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 Any pain or weakness in any of the movements is a positive
test for strain of the affected rotator cuff muscle(s).
Arms Over Head (rotator cuff): 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
High Five Test (rotator cuff): 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
Lift Off Sign (rotator cuff): 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
Resisted Pull Test (tendinitis vs. bursitis): 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.