Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check- offs
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1 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Evidence- Based Examination of the Shoulder Presented by Eric Hegedus, PT, DPT, MHSC, OCS, CSCS Practice Sessions/Skill Check- offs Chapter Seven: Special Tests (1 hour CEUTime) Skilled Process Perform the Passive Compression test Perform the Passive Distraction test Review in Chapter Slide 6 Photo Slide 5 1 Description Check Off The patient is in a sidelying position. The examiner, standing behind patient, stabilizing the affected shoulder by holding the acromioclavicular (AC) joint with one hand and the elbow with the other. The examiner externally rotates the shoulder in 30 degrees of abduction and then pushes the arm proximally while extending the shoulder. Confirmatory findings: pain or a painful click in the glenohumeral joint The patient lies in a supine position. The examiner standing on the affected side of the patient and positions the extremity off the edge of the table, into 150 degrees elevation in the coronal plane, the elbow extended, the forearm supinated, and the upper arm stabilized to prevent humeral rotation. The examiner pronates the forearm while maintaining
2 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Perform the Dynamic Labral Shear test steady position of the humerus. Confirmatory findings: pain reported deep inside the glenohumeral joint either anteriorly or posteriorly The patient is positioned in supine. The examiner, beside the affected arm, lets gravity horizontally abduct the shoulder and places the arm in a position of 90 degrees external rotation and 120 degrees elevation. Abduct the patient s arm from 120 degrees to 90 degrees. Confirmatory findings: deep or posterior shoulder pain The patient is standing. The examiner standing behind patient, guiding involved upper extremity into maximal horizontal abduction and applying a shear load to the joint by maintaining external rotation and horizontal abduction and lowering arm from 120 degrees to 60 degrees of abduction Confirmatory findings: reproduction of pain and/or painful click or catch in the posterior joint line between 120 and 90 degrees abduction Slide 9 Perform the Modified Dynamic Labral Shear test 2
3 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Perform Lateral Jobe test Slide 9 Perform the External Rotation Lag sign Slide 13 The patient is seated or standing. The examiner instructs the patient to abduct their affected shoulder to 90 degrees in the coronal plane with the elbow flexed to 90 degrees and the shoulder internally rotated so that the fingers point inferiorly and the thumbs medially. The examiner then applies an inferior force to the distal arm. Confirmatory findings: pain or weakness or inability to perform the test is indicative of a RC tear The patient is seated. The examiner grasps the patient s elbow with one hand and the wrist with the other. The examiner places the elbow in 90 degrees of flexion and the shoulder in 20 degrees of elevation in the scapular plane. The examiner passively externally rotates the shoulder to near end- range. The examiner asks the patient to maintain this position as the patient s wrist is released. Confirmatory findings: inability of the patient to maintain the arm in full external rotation or a lag 3
4 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Perform the Belly Press test Perform the Bear Hug test Slide 16 Perform the Bony Apprehension test Slide 18 Perform the Olecranon- Manubrium Percussion Test Slide 19 The patient lies can be seated or standing. The patient internally rotates the shoulder, causing the palm of the hand to be pressed into the stomach. Confirmatory findings: A positive test is indicated by the elbow dropping behind the body into extension or the patient using wrist flexion as a substitute for internal rotation The patient assumes a seated position. The patient places the palm of the involved side on the opposite shoulder, elbow flexed and pointing straight ahead, fingers extended. The examiner attempts to pull the hand upward and off of the opposite shoulder. Confirmatory findings: A positive test for subscapularis tear is indicated by the patient being unable to hold the hand against the shoulder. The patient is seated or standing with elbow flexed to 90 degrees. The examiner standing behind patient holding the lateral forearm with one hand and placing the other hand on the posterior aspect of the humeral head. The examiner moves the affected arm into 45 degrees abduction and 45 degrees external rotation. Confirmatory findings: apprehension with or without pain The patient is seated or standing. The examiner taps on the involved side olecranon while using a stethoscope placed on the patient s manubrium. This process is repeated on the uninvolved side and the 4
5 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Perform the Surprise test Slide 21 Perform the AC Resisted Extension test Slide 23 results are compared. Confirmatory findings: A positive test for fracture or dislocation is indicated by a difference in the quality of sound on the involved vs. the uninvolved side. The patient assumes a supine position. The examiner moves the patient s arm into the 90/90 position and maximally externally rotates the humerus. A posterior to anterior force can be applied as needed. The patient should display apprehension with or without pain. Step 2- the examiner provides a manual posterior stabilizing force to the humeral head and pain/apprehension should disappear. Step 3- the examiner removes the manual stabilization and apprehension should reappear. The patient is seated with his or her shoulder in 90 degrees of flexion and internal rotation, and his or her elbow in 90 degrees of flexion. The examiner, standing beside the patient, asks the patient to horizontally abduct his or her arm while the examiner provides an isometric resistance to this movement. Confirmatory findings: A positive test is indicated by pain at the AC joint. 5
6 Evidence- Based Examination of the Shoulder Practice Session & Skills Check- offs Discuss the diagnostic value of scapular dyskinesis and clustering of tests tests Notes: Slide 24 Does scapular dyskinesis have any value? What are the best test clusters? Can you think of potentially better ones? Why are they better? 6
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