Test and mesurment

1. Tests & measurements
in Physical Therapy
Dr. Amani A. Mezher
BSc PT, MD Rehab. MED,
Faculty of Heath sciences –
Physiotherapy Department
The Islamic University of Gaza
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Test &measurement of the
shoulder joint
Dr. Abdallah O. Hamdouna
PHD Health Quality
Faculty of Heath sciences –
Physiotherapy Department
The Islamic University of Gaza

2. Introduction:
 The shoulder joint is a complex joint, with a design that provides maximum
mobility and range of motion.
 It has the greatest range of motion of any joint in the body.
However, this large range of motion can lead to joint problems.
 The joint is composed of three bones. The main two bones are the proximal end
of the humerus and the scapula. The third bone is the clavicle.
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3.  There are actually two joints that make up the shoulder.
a. The main shoulder joint, called the glenohumeral joint , is formed where the head
of the humerus fits into glenoid cavity of the scapula.
b. The second is the acromioclavicular joint, is where the clavicle articulates with the
acromion process of the scapula.
 Articular cartilage is the material that covers the ends of the bones of any joint
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4.  There are several important ligaments in the shoulder.
These ligaments are the main source of stability for the shoulder.
 A special type of ligament forms a unique structure inside the
shoulder called the labrum.
 The labrum is attached almost completely around the edge of the
glenoid. When viewed in cross section, the labrum is wedge-shaped.
The shape and the way the labrum is attached create a deeper cup for
the glenoid socket.
 This is important because the glenoid socket is so flat and shallow
that the ball of the humerus does not fit tightly.
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5.  The rotator cuff is an anatomical term given to the group of muscles
and their tendons that act to stabilize the shoulder.
 These muscles are supraspinatus, infraspinatus, teres minor and
subscapularis muscles.
 These muscles are important because they hold the head of the
humerus in the small and shallow glenoid cavity of the scapula.
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6. Special tests of the shoulder
Empty can (Supraspinatus) test:
Indication:
When supraspinatus muscle pathology is suspected.
Test position:
Patient stands with both shoulders abducted to 90 degrees, horizontal
adducted 30 degrees, and internally rotated so the patient's thumbs face
the floor.
Action:
The therapist resists the patient's attempts to actively abduct both
shoulders.
Results:
Weakness of supraspinatus or pain means a positive test.
Weakness may be the result of suprascapular nerve involvement and pain
may be indicative of tendonitis and or impingement.
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https://www.youtube.com/watch?v=DeO50UTxwoo

8. Drop arm test:
Indication:
When rotator cuff pathology is suspected.
Test position:
Patient is seated on a table or standing.
Action:
The therapist passively abducts the patient's involved arm to 90
degrees and then instructs the subject to slowly lower the arm to the
side.
Results:
Positive finding noted when the patient is unable to slowly return the
arm to the side and/or has significant pain when attempting to perform
the task. This is indicative of cuff pathology.
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https://www.youtube.com/watch?v=JXgRBeqToik

10. Sternoclavicular joint stress test:
 Indication:
This test is indicative with sternoclavicular instability or pathology.
 Test position:
- Patient is in sitting position with the involved arm relaxed at the side.
- The examiner stands in front of the patient placing one hand on the
proximal -end of the patient's clavicle and other hand on the spine of the
scapula
 Action:
The therapist applies gentle downward and inward pressure on the clavicle,
noting any movement at the sternoclavicular joint.
 Results:
Pain and/or movement of the clavicle indicates a sternoclavicular ligament
sprain, possibly involving the costoclavicular ligament.
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12. Acromioclavicular joint distraction test:
 Indication:
This test is indicative with acromioclavicular instability or pathology.
 Test position:
- Patient is in sitting position with the involved arm relaxed at the side and the elbow
flexed to 90 degrees.
- The therapist stands on the involved side holding the patient's arm just above the
elbow.
- The therapist's other hand is placed over the involved acromioclavicular joint.
 Action:
The therapist applies gentle downward pressure on the arm, noting any movement at the
acromioclavicular joint.
 Results:
Pain and/or movement of the scapula inferior to the clavicle is positive, indicating
acromioclavicular and coracoclavicular ligament sprains.
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https://www.youtube.com/watch?v=N5ECz73mJYU

14. Test &measurement of the elbow joint
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15. Introduction:
 The elbow joint is formed by three bones, the humerus, radius, and ulna
 Articulations between the trochlea of the humerus with the ulna and the
capitulum of the humerus with the head of the radius comprise the joint.
 The elbow is an example of a hinge joint, or a joint that moves in only one
direction. It’s a one degree of freedom joint.
 The articular surfaces are connected together by a capsule, which is thickened
medially and laterally, and to a less extent in front and behind.
 There are several ligaments in the elbow joint, the two main ligaments are
present in the elbow joint, the ulnar collateral ligament and the radial collateral
ligament.
 These ligaments provide strength and support to the joint as do the surrounding
muscles.
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16.  The ulnar collateral ligament is a strong fan shaped condensation of
the fibrous joint capsule.
It is located on the medial side of the joint, extending from the medial
epicondyle of the humerus to the proximal portion of the ulna.
This ligament prevents excessive abduction of the elbow joint.
 The radial collateral ligament is also a strong fan shaped
condensation of the fibrous joint capsule.
It is located on the lateral side of the joint, extending from the lateral
epicondyle of the humerus to the head of the radius.
This ligament prevents excessive adduction of the elbow joint.
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17.  The anterior ligament is a broad and thin fibrous layer covering the
anterior surface of the joint.
 This posterior ligament is thin and membranous, and consists of
transverse and oblique fibers.
 There is also an important ligament called the annular ligament that
wraps around the radial head and holds it tight against the ulna.
 The annular ligament forms a ring around the radial head as it holds
it in place.
This ligament can be torn when the entire elbow or just the radial head is
dislocated.
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19. Special tests of the elbow joint:
Resistive tennis elbow test (Cozen's test).
 Indication:
Indicated when tennis elbow is suspected.
 Test position:
Patient is in sitting. The therapist stabilizes the involved elbow while palpating along
the lateral epicondyle
 Action:
With a close fist, the patient pronates and radially deviates the forearm, and extends
the wrist against the therapist's resistance.
 Results:
Pain along the lateral epicondyle region of humerus, or objective muscle weakness as a
result of complaints of discomfort may indicate lateral epicondylitis (Tennis elbow).
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https://www.youtube.com/watch?v=8K7jzDIUpLI

21. Resistive tennis elbow test:
 Indication:
Indicated when tennis elbow is suspected.
 Test position:
- Patient is in sitting position.
- The therapist stabilizes the involved elbow with one hand and places the palm on the
other hand on the dorsal aspect of the patient's hand just to the proximal
interphalangeal joint of the third digit
 Action:
The patient extends the third digit against the therapist's resistance.
 Results:
Pain along the lateral epicondyle region of humerus, or objective muscle weakness as a
result of complaints of discomfort may indicate lateral epicondylitis (Tennis elbow).
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Resistive tennis elbow test.

23. Varus stress test:
 Indication:
Its indicated when radial collateral ligament injury is suspected.
 Test position:
- Patient in sitting position with the tested elbow flexed to 20 to 30 degrees.
- The therapist is standing with the distal hand around patient's wrist and proximal
hand over the patient's elbow joint
 Action:
With the wrist stabilized, apply a varus stress to elbow with the proximal hand.
 Results:
Compared to the uninvolved elbow, lateral pain and or increased varus movement is
indicative of damage to primarily radial collateral ligament.

24. Valgus stress test:
 Indication:
Its indicated when ulnar collateral ligament injury is suspected.
 Test position:
- Patient in sitting position with the tested elbow flexed to 20 to 30 degrees.
- The therapist is standing with the distal hand around patient's wrist
and proximal hand over the patient's elbow joint
 Action:
With the wrist stabilized, apply a valgus stress to elbow with the proximal hand.
 Results:
Compared to the uninvolved joint medial elbow pain and/ or increased valgus
movement with diminished or absent endpoint is indicative of damage to primarily
ulnar collateral ligament.
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https://www.youtube.com/watch?v=5zl8GsG3hR4
https://www.youtube.com/watch?v=3xF9_5fbJ8A

26. Tinel’s sign:
 Indication:
Tinel's test is used to test for compression neuropathy, commonly in diagnosing
cubital tunnel syndrome.
 Test position:
Patient in sitting position with the elbow in slight flexion, and the examiner is standing
with the distal hand grasping the patient's wrist laterally
 Action:
With the wrist stabilized, tap the ulnar nerve in the ulnar notch (between the
olecranon process and medial epicondyle) with the index.
 Results:
Tingling along the ulnar distribution of the forearm, hand , and fingers is indicative of
ulnar nerve compromise.
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https://www.youtube.com/watch?v=ASRatLbu8i0

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