Evidence-Based Shoulder Assessment Outline. By Dana Washburn, MS, OTR/L, CKTP TM.

Transcription

1 Evidence-Based Shoulder Assessment Outline By Dana Washburn, MS, OTR/L, CKTP TM Step 1: Patient History of Shoulder Dysfunction: Ask about onset, symptoms (especially pain and numbness), occupational history and I/ADL dysfunction and dependency; information gathered will suggest possible etiology Step 2: Clinical Examination: Look, Feel, Move. Check for abnormalities in muscles, bony prominences (e.g. scapula), posture; measure range of motion and examine each joint within the shoulder complex Step 3: Special Tests and Individual Muscle Testing: Select special tests based on symptoms; select individual muscle testing based on muscular asymmetry, dysfunction, fluidity of movement and pain Recommended readings regarding shoulder conditions, special tests and individual MMT: Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity (2 nd Ed.) by Cooper (2014), Chapter 22 Special Tests for Orthopedic Examination (4 th Ed.) by Konin et al. (2016), Sections 1 & 2 Muscles: Testing and Function with Posture and Pain (5 th Edition) by Kendall et al. (2005) Special Tests for Cervical Radiculopathy (Wainner r. et al., 2003): Ipsilateral cervical rotation AROM < 60 deg Spurling s Test Distraction Test Upper Limb Tension Test for Median Nerve If all 4 tests are positive this indicates.99 specificity that patient has cervical radiculopathy and he/she should be referred to PT (or kept in OT if appropriate)

2 Special Tests for the Shoulder (Durall 2013, other sources as cited): AC Joint Pathology o AC Joint Palpation (97%), (Walton et al. 2004) o Cross-Body Adduction (79%), (Chronopoulos et al. 2004) o Active Compression Test (~95%), (Chronopoulos et al. 2004, Walton et al. 2004) Shoulder Impingement Sensitive Tests (rules-out when negative) o Neer Test (~80%), Calis et al. 2000, MacDonald et al. 2000, Park et al o Hawkins-Kennedy Test (~80%), Calis et al. 2000, MacDonald et al. 2000, Park et al o Hawkins-Kennedy Test + painful arc + ER weakness in neutral (~95%) Park et al Anterior Instability o Release/Surprise Test (~64%) (Lo et al. 2004) o Apprehension Test (>90%) (Lo et al. 2004, Farber et al. 2006) o Relocation Test (>90%) (Lo et al. 2004, Farber et al. 2006) o Release/Surprise Test (~64%) (Lo et al. 2004, Gross & Distefano 1997) Biceps Tendonitis/Pathology Sensitive Test (rule-out when negative) o Upper cut (77%) (Kibler et al. 2009) Specific Tests (rule-in when positive) o Speed s test (~83%) (Kibler et al. 2009) o Belly Press (~83%) (Kibler et al. 2009)

3 Anterior-Inferior Labral Pathology o Crank Test + history of popping, clicking, or catching (91%) (Walsworth et al. 2008) Supraspinatus Tear o Drop Arm Test (~90%) (Calis et al. 2000, Murrell & Walton 2001, Park et al. 2005) Infraspinatus Tear o External Rotation Lag Sign (~90%), (Park et al. 2005, Miller et al. 2008, Walch et al. 1998) Subscapularis Tear o Bear Hug Test (82%) (Barth et al. 2012) Specific Test (rules-in when positive) o Lift-Off Test (~70%) (Leroux et al. 1995, Barth et al. 2012)

4 References Barth, J., Audebert, S., Toussaint, B., Charousset, C., Godeneche, A., Graveleau, N., Joudet, T., Lefebvre, Y., Nove-Josserand, L., Petroff, E., Solignac, N. Scymanski, C., Pitermann, M., Thelu, C.E. (2012). Diagnosis of subscapularis tendon tears: Are available diagnostic tests pertinent for a positive diagnosis? Orthopaedics & Traumatology: Surgery & Research (98S): S178-S185 Calis, M., Akgun, K., Birtane, M., Karacan, I., Calis, I., Tuzun, R. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the Rheumatic Diseases 59(1): Chronopoulos, E., Kim, T., Park, H., Ashenbrenner, D., McFarland, E. (2004). Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. American Journal of Sports Medicine 32: Cooper, Cynthia (Ed.). (2014). Fundamentals of hand therapy: clinical reasoning and treatment guidelines for common diagnoses of the upper extremity (2 nd Ed.). St. Louis: Mosby Elsevier. Donnelly, T., Ashwin, S., MacFarlane, R., Waseem, M. (2013). Clinical assessment of the shoulder. Open Orthopaedics Journal 7 (Suppl 3: M3): Durall, C. (2013). Evidence-based clinical examination of the shoulder complex. From North American Seminars, Inc. continuing education course, Comprehensive Examination and Treatment of Shoulder Disorders: What are you missing? Kenosha, WI. Farber, A., Castillo, R., Clough, M., Bahk, M., McFarland, E. (2006). Journal of Bone & Joint Surgery 88(7): Gross, M., Distefano, M. (1997). Anterior release test: a new test of occult shoulder instability. Clinical Orthopaedics and Related Research Jun; (339): Grubb, S., Kelly, C. (2000). Cervical discography: clinical implications from 12 years of experience. Spine 25 (11): Hermans, J., Luime, J., Meuffels, D., Reijman, M., Simel, D., Bierma-Zeinstra, S. (2013). Does this patient with shoulder pain have rotator cuff disease? The rational clinical examination systematic review. Journal of the American Medical Association 310(8): Kilber, W., Sciascia, A., Hester, P., Dome, D., Jacobs, C. (2009). Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. American Journal of Sports Medicine 37:

5 Leroux, J., Thomas, E., Bonnell, F., Blotman, F. (1995). Diagnostic value of clinical tests for shoulder impingement syndrome. Revue du Rheumatisme, English Edition 62: Limb, D., Limb, R. (2014). Clinical assessment of the shoulder. Archives of Orthopaedic & Trauma Surgery 28(6): Lo, I., Nonweiler, B., Woolfrey, M., Litchfield, R., Kirkley, A. (2004). An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. American Journal of Sports Medicine 32(2): MacDonald, P., Clark P., Sutherland, K. (2000). An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. Journal of Shoulder and Elbow Surgery 9(4): Miller, C., Forrester, G., Lewis, J. (2008). The validity of the lag signs in diagnosing fullthickness tears of the rotator cuff: a preliminary investigation. Archives of Physical Medicine and Rehabilitation Jun; 89(6): Murrell, G., Walton, J. (2001). Diagnosis of rotator cuff tears. Lancet Mar 10; 357 (9258): Netter, F. (2011). Atlas of human anatomy (5 th Ed.) Philadelphia: Saunders Elsevier. Park, H., Yokota, A., Gill, H., El Rassi, G., McFarland E. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. Journal of Bone & Joint Surgery (American) Jul; 87(7): Wainner r. et al. (2003). Reliability and Diagnostic Accuracy of the Clinical Examination and Patient Self-Report Measures for Cervical Radiculopathy. Spine 1 January 2003, Vol.28(1), pp Walch, G., Boulahia, A., Calderone, S. (1998). The dropping and hornblower s signs in evaluation of rotator-cuff tears. Journal of Bone & Joint Surgery (British) 80: Walsworth, M. Doukas, W., Murphy, K., Mielcarek, B., Michener, L. (2008). Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears. American Journal of Sports Medicine Jan; 36(1): Walton, J. Mahajan, S. Paxinos, A., Marshall, J., Bryant, C., Shnier, R., Quinn, R., Murrell, G. (2004). Diagnostic values of tests for acromioclavicular joint pain. Journal of Bone & Joint Surgery (American) 86: