Shoulder Obj Assessment

• Observations

  check facial behaviour - grimacing, emotions...

  posture - guarding, kyphosis, lordosis, flat back, forward head posture

  gait - shuffling, limping, dragging, waddling...
• Postures - Kyphosis

  excessive forward rounding of the upper back

  caused by weakness in the spinal bones

  
• Postures - Lordosis

  exaggerated inward curve of the spine that typically affects the lower back

  
• Inspection - Bony Deformities

  cervical position

  spinal curvatures

  shoulder + scapulae positions - check for tilts/misalignment

  lumps, scars, bony prominences
• Inspection - Muscle Wasting

  check for loss of muscle tone in supraspinatus, infraspinatus + upper traps

  
• Inspection - Colour & Swelling

  check for bruises/redness - signs of inflammation

  palpate skin - temp check for inflammation
• State @ Rest

  check if the patient is alert to time, enviro + self

  ask about mood - sleepy, happy, depressed...
• Objective - Eliminate Cervical Region

  test AROM of neck

  lateral, anterior, posterior flexion

  rotation of neck

  used to hone down onto the possibe site of injury/pain
• Active Shoulder Extension

  extension = shoulder joint extends, increasing the angle between the humerus + the trunk

  moving the arm behind the torso - norm ROM: 45-60

  driven by latissimus dorsi, posterior deltoid + teres major

  
• Active Shoulder Flexion

  movement of the arm forward + uward, decreasing the angle between the humerus + the sapula

  norm ROM = approx 180

  
• Active Shoulder Medial Rotation

  inward rotation of humerus towards the midline of the body while elbow remains bent at 90

  controlled by subscapularis, pectoralis major + latissimus dorsi

  norm ROM: 70-90

  
• Active External Shoulder Rotation

  moving arm outwards at the shoulder joint away from the midline of the body, w the elbow bent at 90

  external rotator muscles = infraspinatus + teres minor

  
• Active Shoulder Abduction

  move arm to the side away from body 0-90

  supraspinatus, deltoid + other rotator cuff muscles r involved
• Painful Arc

  passive abduction from 0-180

  palpate scapula + upper back at pt does movement

  check for any abnormalities - excessive strain, struggling, stiffness in movement
• Passive Shoulder Movements

  aiding the pt thru their full ROM

  helps identify symptoms and its site

  pt isn't activley engaging their muscles

  purpose = maintain/increase joint mobility + prevent stifness
• Resisted Physiological Movements

  asseses muscle strength + function

  diagnoses neuromuscular dysfunction

  facilitates rehab by improving strength + endurance
• Special Test - Scarf Test

  cross-abduction = used to assess the integrity of the ACJ

  passively bring pt's arm into 90 forward flexion, elbow flexed at 90

  horiz abduct flexed arm across the pt's body, bringing elbow towards the contralateral shoulder

  results in the compression of the medial acromial facet against the distal clavicle to provoke symptoms at the ACJ
• Special Test - Hawkins-Kennedy Test

  testing for subacromial impingement syndrome

  elevate arm at 90 forward flexion, elbow flexed at 90, let it rest on ur forearm as u stabilise contralateral shoulder
• Special Test - Empty Can Test

  suprapinatus test = assess lesions of the rotator cuff, specifically the supraspinatus muscle + supraspinatus tendon

  arms flexed at 90, abducted to scapula plane, fisted hands, thumbs down (internal rotation of shoulder)

  press down on wrists and tell pt to resist

  
• Myotomes

  C4 - shoulder girdle elevation

  C5 - shoulder abduction

  C6 - elbow extension

  C8 - thumb extension

  T1 - finger adduction