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SPECIAL TESTS OF SHOULDER JOINTAarti SareenMSPT-I semester(honours)
NORMAL RANGE OF MOTION OF SHOULDERJOINT:
SPECIAL TESTS FOR SHOULDER JOINT:TESTS FOR            TESTS FOR      TESTS FOR      TESTS FORROTATOR              ACROMIOC...
TESTS FOR ROTATOR CUFFAND IMPINGMENT SYNDROME
IMPINGEMENT:Primary impingment                  Secondary impingmentOccur because of degenerative       Occurs due to prob...
GRADING OF IMPINGEMET:   Mostly impingement and instability often occurs    together in throwing athletes and accordingly...
NEER IMPINGMENT TEST:PATIENT’S AFFECTED ARM IS PASSIVELY AND FORCIBLY FULLYELEVATED IN THE SCAPULAR PLANE WITH THE ARM MED...
HAWKIN’S KENNEDY IMPINGMENT TEST: PATIENT STAND WHILE THE EXAMINER FORWARD FLEXS THE ARM TO90º AND FORCIBLY MEDIALLY ROTAT...
SUPRASPINATUS TEST/EMPTY CAN TEST: THIS TEST MAY BE PERFORMED WITH THE PATIENT STANDING ORSEATED.WITH THE ELBOW EXTENDED, ...
DROP ARM(CODMAN’S)TEST:THE PATIENT IS SEATED, AND THE EXAMINER PASSIVELY ABDUCTS THEPATIENT’S EXTENDED ARM APPROXIMATELY 1...
SUBSCAPULARIS TEST/LIFT OFF TEST: PATIENT IN STANDING POSITION PLACES THE DORSUM OF THE HANDON THE BACK. THE PATIENT THEN ...
INFRASPINATUS TEST: COMPARATIVE TESTING OF BOTH SIDES IS BEST. THE PATIENT’SARMS SHOULD HANG RELAXED WITH THE ELBOWS FLEXE...
 SPRING   BACK TEST:PATIENT EITHER IN SITTING OR STANDING HOLD THE  ELBOW IN FLEXION AT 90º BY THE SIDE. EXAMINER  PASSIV...
TERES MAJOR TEST:THE PATIENT IS STANDING AND RELAXED. THE EXAMINER ASSESSESTHE POSITION OF THE PATIENT’S HANDS FROM BEHIND...
APLEY’S SCRTCH TEST:THE SEATED PATIENT IS ASKED TO TOUCH THE CONTRALATERALSUPERIOR MEDIAL CORNER OF THE SCAPULA WITH THE I...
ACROMIOCLAVICULAR JOINTTESTS
TOSSY CLASSIFICATION:   TOSSY TYPE 1: CONTUSION OF THE    ACROMIOCLAVICULAR JOINT WITHOUT    SIGNIFICANT INJURY TO THE CA...
ACROMIOCLAVICULAR JOINT PROBLEM   MAY BE ELICITED BY ANTERIOR PAIN WITH MOTION AND    TENDERNESS TO PALPATION OVER THE   ...
PAINFUL ARC:THE PATIENT’S ARM IS PASSIVELY AND ACTIVELY ABDUCTED FROM THEREST POSITION ALONGSIDE THE TRUNK. PAIN IN THEACR...
FORCED ADDUCTION TEST:THE 90°-ABDUCTED ARM ON THE AFFECTED SIDE IS FORCIBLYADDUCTED ACROSS THE CHEST TOWARD THE NORMAL SID...
DUGA’S TEST: THE PATIENT IS SEATED OR STANDING AND TOUCHES THECONTRALATERAL SHOULDER WITH THE HAND OF THE 90°-FLEXED ARM O...
BICEP TENDON TESTTHE CLOSE ANATOMIC PROXIMITY OF THEINTRAARTICULAR PORTION OF THE TENDONTO THE CORACOACROMIAL ARCHPREDISPO...
SPEED TEST: IN SITTING THE EXAMINER RESISTS SHOULDER FORWARDFLEXION BY THE PATIENT WHILE THE PATIENT’S FOREARM IS INSUPINA...
YERGASON TEST:WITH THE PATIENT’S ELBOW FLEXED TO 90º AND STABILIZED AGAINSTTHORAX AND WITH FOREARM PRONATED, THE EXAMINER ...
BICEP TENDINITIS WITH TRANSVERSE HUMERALLIGAMENT TEST:THE PATIENT IS SEATED WITH THE ARM ABDUCTED 90°, INTERNALLYROTATED, ...
INSTABILITY TESTSSHOULDER PAIN MAY BE ATTRIBUTABLE TO ANUNSTABLE SHOULDER. USUALLY HISTORY OF A PERIODOF INTENSIVE SHOULDE...
ANTERIOR APPREHENSION TEST: PATIENT LIE SUPINE OR IN SITTING . ARM IS ABDUCTED TO 90ºAND LATERALLY ROTATED SLOWLY BY THE E...
NOTE:When the patient complains of sudden stabbing pain with simultaneous or subsequent paralyzing weakness in the affecte...
POSTERIOR APPREHENSION TEST: PATIENT LIES SUPINE OR IN SITTING POSITION AND EXAMINERFORWARD FLEX SHOULDER TO 90º WHILE STA...
ANTERIOR AND POSTERIOR DRAWER TEST:THE PATIENT IS SEATED. THE EXAMINER STANDS BEHIND THE PATIENT.TO EVALUATE THE RIGHT SHO...
INFERIOR APPREHENSION TEST/FEAGIN TEST:PATIENT STANDS WITH THE ARM ABDUCTED TO 90º AND ELBOWEXTENDED AND RESTING ON TOP OF...
SULCUS TEST:PATIENT STANDS WITH ARM BY THE SIDE AND SHOULDERMUSCLE RELAXED. THE EXAMINER GRASPS THE PATIENT’SFOREARM BELOW...
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Tests for shoulder joint

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Transcript of "Tests for shoulder joint"

  1. 1. SPECIAL TESTS OF SHOULDER JOINTAarti SareenMSPT-I semester(honours)
  2. 2. NORMAL RANGE OF MOTION OF SHOULDERJOINT:
  3. 3. SPECIAL TESTS FOR SHOULDER JOINT:TESTS FOR TESTS FOR TESTS FOR TESTS FORROTATOR ACROMIOCLAVI BICEP TENDON INSTABILITYCUFF/IMPINGM CULAR JOINTENT1. NEER 1. PAINFUL ARC 1. SPEED TEST 1. ANTERIOR IMPINGMENT TEST 2. FORCED 2. YERGASON APPREHENSI2. HAWKINS ADDUCTION TEST ON TEST KENNEDY TEST3. EMPTY CAN TEST TEST 3. BICEP 2. POSTERIOR4. DROP ARM TEST 3. FORCED TENDON APPREHENSI5. LIFT OFF.TEST ADDUCTION WITH ON TEST6. INFRASPINATUS TEST TEST IN TRANSVERS 3. ANTERIOR7. SPRING BACK HANGING E HUMERAL POSTERIOR TEST ARM LIGAMENT DRAWER8. TERES MINOR TEST 4. DUGA’S TEST TEST TEST9. TERES MAJOR 4. INFERIOR TEST10. APLEY SCRATCH INSTABILITY TEST TEST 5. SULCUS TEST
  4. 4. TESTS FOR ROTATOR CUFFAND IMPINGMENT SYNDROME
  5. 5. IMPINGEMENT:Primary impingment Secondary impingmentOccur because of degenerative Occurs due to problem withchanges to the rotator cuff,the muscle dynamics with an upset inacromian process,the coracoid the normal force couple actionprocess and anterior tissues from leading to muscle imbalance andstress overload. abnormal movement patterns at both the glenohumeral joint and the scapulothoracic articulation.Impingement is primary cause of It is secondary to altered musclepain. dynamics.Occurs mostly in 40+ age group Occurs in young patients.(15-people. 35years old)It is said to be intrinsic when Commonly seen with jointrotator cuff degeneration occurs instability.and extrinsic when the shape ofthe acromian and degeneration ofthe coracoacromial ligamentoccurs.
  6. 6. GRADING OF IMPINGEMET: Mostly impingement and instability often occurs together in throwing athletes and accordingly it is classified as: GRADE I: GRADE II: GRADE III: GRADE IV: Pure Secondary Secondary Primary impingement impingment impingement instability with with no and instability and instability no instability.(ofte caused by caused by impingement. n seen in older chronic generalized patients) capsular and hypermobility labral or laxity. microtrauma.
  7. 7. NEER IMPINGMENT TEST:PATIENT’S AFFECTED ARM IS PASSIVELY AND FORCIBLY FULLYELEVATED IN THE SCAPULAR PLANE WITH THE ARM MEDIALLYROTATED BY THE EXAMINER. •This passive stress causes “jamming of the greater tuberosity against the anteroinferior border of the acromian. •The patient’s face shows pain reflecting a +ve test.
  8. 8. HAWKIN’S KENNEDY IMPINGMENT TEST: PATIENT STAND WHILE THE EXAMINER FORWARD FLEXS THE ARM TO90º AND FORCIBLY MEDIALLY ROTATES THE SHOULDER. •This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. •Pain indicates +ve test.
  9. 9. SUPRASPINATUS TEST/EMPTY CAN TEST: THIS TEST MAY BE PERFORMED WITH THE PATIENT STANDING ORSEATED.WITH THE ELBOW EXTENDED, THE PATIENT’S ARM IS HELD AT90° OF ABDUCTION,30° OF HORIZONTAL FLEXION, AND IN INTERNALROTATION (WITH THUMB FACING DOWN). THE EXAMINER EXERTSPRESSURE ON THE UPPER ARM DURING THE ABDUCTION ANDHORIZONTAL FLEXION MOTION. •When this test elicits severe pain and the patient is unable to hold his or her arm abducted 90° against gravity, this is called a positive empty can test/supraspinatus tendinitis. •The superior portions of the rotator cuff (supraspinatus) are particularly assessed in internal rotation (with the thumb down), and the •anterior portions in external rotation.
  10. 10. DROP ARM(CODMAN’S)TEST:THE PATIENT IS SEATED, AND THE EXAMINER PASSIVELY ABDUCTS THEPATIENT’S EXTENDED ARM APPROXIMATELY 120°. THE PATIENT ISASKED TO HOLD THE ARM IN THIS POSITION WITHOUT SUPPORT ANDTHEN SLOWLY ALLOW IT TO DROP. Weakness in maintaining the position of the arm, with or without pain, or sudden dropping of the arm suggests a rotator cuff lesion. Most often this is due to a defect in the supraspinatus. In pseudoparalysis, the patient will be unable to lift the affected arm. This global sign suggests a rotator cuff disorder.
  11. 11. SUBSCAPULARIS TEST/LIFT OFF TEST: PATIENT IN STANDING POSITION PLACES THE DORSUM OF THE HANDON THE BACK. THE PATIENT THEN LIFTS THE HAND AWAY FROM THEBACK. IF PATIENT IS ABLE TO DO THEN LOAD PUSHING ON HAND ISDONE BY THE EXAMINER TO CHECK THE STRENGH. •A patient with a subscapularis tear will be unable to do this. •Abnormal motion in the scapula during the test may indicate scapular instability.
  12. 12. INFRASPINATUS TEST: COMPARATIVE TESTING OF BOTH SIDES IS BEST. THE PATIENT’SARMS SHOULD HANG RELAXED WITH THE ELBOWS FLEXED 90° BUTNOT QUITE TOUCHING THE TRUNK. THE EXAMINER PLACES HIS ORHER PALMS ON THE DORSUM OF EACH OF THE PATIENT’S HANDS ANDTHEN ASKS THE PATIENT TO EXTERNALLY ROTATE BOTH FOREARMSAGAINST THE RESISTANCE OF THE EXAMINER’S HANDS. Pain or weakness in external rotation indicates a disorder of the infraspinatus (external rotator). As infraspinatus tears are usually painless, weakness in rotation strongly suggests a tear in the muscle. This test can also be performed with the arm abducted 90° and flexed 30° to eliminate involvement of the deltoid in this motion.
  13. 13.  SPRING BACK TEST:PATIENT EITHER IN SITTING OR STANDING HOLD THE ELBOW IN FLEXION AT 90º BY THE SIDE. EXAMINER PASSIVELY BRING THE SHOULDER TO 90º ABDUCTION AND LATERALLY ROTATE TO THE END RANGE AND ASK THE PATIENT TO HOLD THE ARM TO THIS POSITION. FOR +VE TEST OF INFRASPINATUS WEAKNESS/LESION PATIENT CANNOT HOLD THE POSITION AND HAND SPRING BACK ANTERIORLY.TERES MINOR TEST:PATIENT LIES PRONE AND PLACES HIS HAND ON THE OPPOSITE POSTERIOR ILIAC CREST. ASK THE PATIENT TO EXTEND AND ADDUCT THE MEDIALLY ROTATED ARM AGAINST RESISTANCE. PAIN OR WEAKNESS INDICATE +VE TEST.
  14. 14. TERES MAJOR TEST:THE PATIENT IS STANDING AND RELAXED. THE EXAMINER ASSESSESTHE POSITION OF THE PATIENT’S HANDS FROM BEHIND. THE TERESMAJOR IS AN INTERNAL ROTATOR. WHERE A CONTRACTURE ISPRESENT, THE PALM OF THE AFFECTED HAND WILL FACE BACKWARDCOMPARED WITH THE CONTRALATERAL HAND .
  15. 15. APLEY’S SCRTCH TEST:THE SEATED PATIENT IS ASKED TO TOUCH THE CONTRALATERALSUPERIOR MEDIAL CORNER OF THE SCAPULA WITH THE INDEXFINGER . Pain elicited in the rotator cuff and failure to reach the scapula because of restricted mobility in external rotation and abduction indicate rotator cuff pathology (most probably involving the supraspinatus).
  16. 16. ACROMIOCLAVICULAR JOINTTESTS
  17. 17. TOSSY CLASSIFICATION: TOSSY TYPE 1: CONTUSION OF THE ACROMIOCLAVICULAR JOINT WITHOUT SIGNIFICANT INJURY TO THE CAPSULE AND LIGAMENTS. TOSSY TYPE 2: SUBLUXATION OF THE ACROMIOCLAVICULAR JOINT WITH RUPTURE OF THE ACROMIOCLAVICULAR LIGAMENTS. TOSSY TYPE 3: DISLOCATION OF THE ACROMIOCLAVICULAR JOINTWITH ADDITIONAL RUPTURE OF THE CORACOCLAVICULAR LIGAMENTS.
  18. 18. ACROMIOCLAVICULAR JOINT PROBLEM MAY BE ELICITED BY ANTERIOR PAIN WITH MOTION AND TENDERNESS TO PALPATION OVER THE ACROMIOCLAVICULAR JOINT. FINDINGS WILL OFTEN INCLUDE PALPABLE BONY THICKENING OF THE ARTICULAR MARGIN. TOSSY CLASSIFIES ACROMIOCLAVICULAR JOINT INJURIES INTO THREE DEGREES OF SEVERITY:
  19. 19. PAINFUL ARC:THE PATIENT’S ARM IS PASSIVELY AND ACTIVELY ABDUCTED FROM THEREST POSITION ALONGSIDE THE TRUNK. PAIN IN THEACROMIOCLAVICULAR JOINT OCCURS BETWEEN 140°AND 180° OFABDUCTION. INCREASING ABDUCTION LEADS TO INCREASING COM-PRESSION AND CONTORTION IN THE JOINT. (IN AN IMPINGEMENTSYNDROME OR A ROTATOR CUFF TEAR, BY COMPARISON, PAINSYMPTOMS WILL OCCUR BETWEEN 70°AND 120°. In the evaluation of the active and passive ranges of motion, the patient can often avoid the painful arc by externally rotating the arm while abducting it. This increases the clearance between the acromion and the diseased tendinous portion of the rotator cuff, avoiding impingement in the range between 70° and 120°.
  20. 20. FORCED ADDUCTION TEST:THE 90°-ABDUCTED ARM ON THE AFFECTED SIDE IS FORCIBLYADDUCTED ACROSS THE CHEST TOWARD THE NORMAL SIDE.FORCED ADDUCTION TEST ON HANGING ARM:THE EXAMINER GRASPS THE UPPER ARM OF THE AFFECTED SIDEWITH ONE HAND WHILE THE OTHER HAND RESTS ON THE CONTRALATERALSHOULDER AND IMMOBILIZES THE SHOULDER GIRDLE.THEN THE EXAMINERFORCIBLY ADDUCTS THE HANGING AFFECTED ARM BEHIND THE PATIENT’SBACK AGAINST THE PATIENT’S RESISTANCE. Pain across the anterior aspect of the shoulder suggests acromioclavicular joint disease or subacromial impingement.
  21. 21. DUGA’S TEST: THE PATIENT IS SEATED OR STANDING AND TOUCHES THECONTRALATERAL SHOULDER WITH THE HAND OF THE 90°-FLEXED ARM OF THE AFFECTED SIDE THEN ATTEMPT TO LOWERTHE ELBOW TO THE CHEST IS MADE. Acromioclavicular joint pain suggests joint disease (osteoarthritis, instability, disk injury, or infection). A differential diagnosis must exclude anterior subacromial impingement
  22. 22. BICEP TENDON TESTTHE CLOSE ANATOMIC PROXIMITY OF THEINTRAARTICULAR PORTION OF THE TENDONTO THE CORACOACROMIAL ARCHPREDISPOSES IT TO INVOLVEMENT INDEGENERATIVE PROCESSES IN THESUBACROMIAL SPACE. A ROTATOR CUFF TEARIS OFTEN ACCOMPANIED BY A RUPTURE ORINJURIES OF THE BICEPS TENDON.
  23. 23. SPEED TEST: IN SITTING THE EXAMINER RESISTS SHOULDER FORWARDFLEXION BY THE PATIENT WHILE THE PATIENT’S FOREARM IS INSUPINATION. PAIN IN THE REGION OF THE BICIPITAL GROOVESUGGESTS A DISORDER OF THE LONG HEAD OF THE BICEPSTENDON.
  24. 24. YERGASON TEST:WITH THE PATIENT’S ELBOW FLEXED TO 90º AND STABILIZED AGAINSTTHORAX AND WITH FOREARM PRONATED, THE EXAMINER RESISTSSUPINATION WHILE THE PATIENT ALSO LATERALLY ROTATES THE ARMAGAINST RESISTANCE. DURING THIS MOVEMENT WHEN THE TENDONIS FELT IN GROOVE AS “POP OUT” . •Pain in the bicipital groove is a sign of a lesion of the biceps tendon, its tendon sheath, or its ligamentous connection via the •transverse ligament. •The typical provoked pain can be increased by pressing on the tendon in the bicipital groove.
  25. 25. BICEP TENDINITIS WITH TRANSVERSE HUMERALLIGAMENT TEST:THE PATIENT IS SEATED WITH THE ARM ABDUCTED 90°, INTERNALLYROTATED, AND EXTENDED AT THE ELBOW. FROM THIS POSITION, THEEXAMINER EXTERNALLY ROTATES THE ARM WHILE PALPATING THEBICIPITAL GROOVE TO VERIFY WHETHER THE TENDON SNAPS. •In the presence of ligamentous insufficiency, this motion will cause the biceps tendon to spontaneously displace out of the bicipital groove. •Pain reported without displacement suggests biceps •tendinitis.
  26. 26. INSTABILITY TESTSSHOULDER PAIN MAY BE ATTRIBUTABLE TO ANUNSTABLE SHOULDER. USUALLY HISTORY OF A PERIODOF INTENSIVE SHOULDER USE (SUCH AS COMPETITIVESPORTS), AN EPISODE OF REPEATED MINOR TRAUMA(OVERHEAD USE), OR GENERALIZED LIGAMENT LAXITY.BOTH YOUNG ATHLETES AND INACTIVE PERSONS AREAFFECTED, MEN AND WOMEN ALIKE.
  27. 27. ANTERIOR APPREHENSION TEST: PATIENT LIE SUPINE OR IN SITTING . ARM IS ABDUCTED TO 90ºAND LATERALLY ROTATED SLOWLY BY THE EXAMINER. WHILEPERFORMING PATIENT’S EXPRESSIONS ARE NOTED FORAPPREHENSION/FURTHER RESISTENCE TO ROTATION. THETEST IS PERFORMED AT 60°, 90°, AND 120° OF ABDUCTION TOEVALUATE THE SUPERIOR, MEDIAL, AND INFERIORGLENOHUMERAL LIGAMENTS. WITH THE GUIDING HAND, THEEXAMINER PRESSES THE HUMERAL HEAD IN AN ANTERIOR ANDINFERIOR DIRECTION Shoulder pain with reflexive muscle tensing is a sign of an anterior instability syndrome. This muscle tension is an attempt by the patient to prevent imminent subluxation or dislocation of the humeral head.
  28. 28. NOTE:When the patient complains of sudden stabbing pain with simultaneous or subsequent paralyzing weakness in the affected extremity, this is referred to as the “dead arm sign.” It is attributable to the transient compression the subluxated humeral head exerts on the plexus. It is important to know that at 45° of abduction, the test primarily evaluates the medial glenohumeral ligament and the subscapularis tendon. At or above 90° of abduction, the stabilizing effect of the subscapularis is neutralized and the test primarily evaluates the inferior glenohumeral ligament.
  29. 29. POSTERIOR APPREHENSION TEST: PATIENT LIES SUPINE OR IN SITTING POSITION AND EXAMINERFORWARD FLEX SHOULDER TO 90º WHILE STABILIZING THE SCAPULAWITH OTHER HAND. EXAMINER THEN APPLIES A POSTERIOR FORCEON THE ELBOW AND MOVES THE ARM IN ADDUCTION AND MEDIALLYROTATION.
  30. 30. ANTERIOR AND POSTERIOR DRAWER TEST:THE PATIENT IS SEATED. THE EXAMINER STANDS BEHIND THE PATIENT.TO EVALUATE THE RIGHT SHOULDER, THE EXAMINER GRASPS THEPATIENT’S SHOULDER WITH THE LEFT HAND TO STABILIZE THECLAVICLE AND SUPERIOR MARGIN OF THE SCAPULA WHILE USING THERIGHT HAND TO MOVE THE HUMERAL HEAD ANTERIORLY ANDPOSTERIORLY.
  31. 31. INFERIOR APPREHENSION TEST/FEAGIN TEST:PATIENT STANDS WITH THE ARM ABDUCTED TO 90º AND ELBOWEXTENDED AND RESTING ON TOP OF THE EXAMINER’S SHOULDER.EXAMINER CLASP HIS/HER HANDS AROUND THE PATIENT’S HUMERUSAND PUSHES THE HUMERUS DOWN AND FORWARD. IN THIS SULCUSMAY ALSO BE SEEN ABOVE THE CORACOID PROCESS.
  32. 32. SULCUS TEST:PATIENT STANDS WITH ARM BY THE SIDE AND SHOULDERMUSCLE RELAXED. THE EXAMINER GRASPS THE PATIENT’SFOREARM BELOW THE ELBOW AND PULLS THE ARM DISTALLY.THE PRESENCE OF SULCUS/INDENTATION INFERIOR TOACROMIAN IS THE INDICATIVE.
  33. 33. THANK YOU
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