MSK Tut 17

• • for radial nerve provocation test - if you move your head away from the body, it actually eases the symptoms
  • for median and ulna nerve provocation test - moving your head away from the body worsens symptoms
• main impairments of the shoulder:

  • weakness - look at cuff integrity tests - belly press, empty/full can, external rotation lag, speeds test
  • loss of rom
  • instability
  • pain - probably subacromial pathology - painful arc
• Belly press:

  • RC weakness would be indicated by pts not being able to keep their palm on their belly, and may compensate by moving elbow etc
• Speeds test:

  • test long head of biceps
  • extended elbow, shoulder flexion to 90 degrees, hand in supination
  • push down on pts arm as pts try to resist
  • similar to empty can, but with empty can you go into the scapular plane with internal rotation
• Empty/Full can:

  • abduct/horizontally arm to 90 degrees, then go into scapular plane
  • thumb down is empty can - should be more pain due to more pressure within the supraspinatus tendon
  • thumb up is full can - should be less pain due to less pressure within supraspinatus tendon
• External Lag:

  • tests all external rotators - subscapularis, supraspinatus etc
  • keep pts in natural abduction position (around 46/60 degrees), then put pts into full external rotation
  • if pts cant maintain external rotation it indicates a positive test
• Anterior Apprehension test:

  • pts lie down
  • 90 degrees abduction and then external rotation - note when pts pain comes on
  • apply AP glide at humeral head
  • mimics pain in overhead activities
• Posterior Apprehension test:

  • right harm passively horizontal flexes, abducts and medially rotates whilst applying AP pressure through elbow down to the humeral head
  • keep scapula stabilised
  • mimics pain on FOOSH
• Inferior Sulcus:

  • stabilise the top of the shoulder
  • pull down on the humerus and maintain the hold
  • pain would be a positive test
• Subacromial pathologies:

  • usually diagnosed used cluster test:
  • neers
  • hawkinskennedy
  • empty can
  • painful arc
  • painful resisted external rotation
• neers:

  • going into too much horizontal flexion can involve AC joint structures
• Active compression (O'Brians):

  • for SLAP lesions
  • horizontal flexion to 90 degrees - thumb down resisted (internal rotation) and then thumb up resisted (external rotation)