Sarah Rayner ESP Physiotherapist Dr Tim Hughes GPSI MSK Orthopaedic Services History Frozen shoulder Primary GHJ osteoarthritis Secondary GHJ osteoarthritis ACJ osteoarthritis SCJ osteoarthritis ID: 630346
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Slide1
Shoulder and Elbow Assessment
Sarah Rayner ESP Physiotherapist
Dr Tim Hughes GPSI
MSK Orthopaedic ServicesSlide2Slide3
History
Frozen shoulder
Primary GHJ osteoarthritis
Secondary GHJ osteoarthritis
ACJ osteoarthritisSCJ osteoarthritisJoint laxitySubacromial impingementInternal impingement
Anterior dislocationMultidirectional instabilityPosterior dislocationFracture ACJ injuryNeoplasmReferred pain from neck Referred pain from viscera
Consider at baseline: age, general health and co-morbidities, nature/mechanism of onset (trauma?), pain distribution, pain behaviour (e.g. night pain, inability to lie on affected side, dead arm syndrome, catching), aggravating/easing (e.g. overhead activities), stiffness, weakness, paraesthesia, joint sounds, functional impairments and previous treatments.
SLAP lesion
Bursitis
Tendinosis
Rotator cuff tear
Spinal accessory neuritis
Suprascapular neuritis
Long thoracic neuritis
Parsonage-Turner syndrome
Anterior instabilitySlide4
History
Frozen shoulder
Primary GHJ osteoarthritis
Secondary GHJ osteoarthritis
ACJ osteoarthritisSCJ osteoarthritisJoint laxitySubacromial impingementInternal impingement
Anterior dislocationMultidirectional instabilityPosterior dislocationFracture ACJ injuryNeoplasmReferred pain from neck Referred pain from viscera
Consider at baseline: age, general health and co-morbidities, nature/mechanism of onset (trauma?), pain distribution, pain behaviour (e.g. night pain, inability to lie on affected side, dead arm syndrome, catching), aggravating/easing (e.g. overhead activities), stiffness, weakness, paraesthesia, joint sounds, functional impairments and previous treatments.
SLAP lesion
Bursitis
Tendinosis
Rotator cuff tear
Spinal accessory neuritis
Suprascapular neuritisLong thoracic neuritisParsonage-Turner syndromeAnterior instability
>45
>60
>45
<40
>25
Young adults
<30
Recurrence likelier in younger individuals; primary injury
<40
Young adults
>40
often causes cuff tears in the older
>35Slide5
Shoulder: Common conditions
Impingement
Rotator Cuff tears
Frozen shoulder
AC joint painSlide6
Standard tests
Observations
Deformity, wasting, heat, effusion, winging, bony contours
Active movements
Neck x 6 (flex, ext, side flex and rot)
Shoulder girdle elevation (SCJ, ACJ)Shoulder elevation (plus passive over-pressure) Does the movement look “right”?Is active range full? If not:Is the joint stiff?If the joint isn’t stiff, lost range may be due to weakness
or pain. Painful arc? (impingement)Apley scratch test: hand down neck & hand up back (evaluate function)
Passive movements
Lateral rotation
* (capsular pattern)
Isometric actions
Resisted
tests
Abduction
Adduction Lateral RotationMedial RotationRotator cuff tests
Full can test (supraspinatus)Drop sign (Massive RC tear)
ER lag sign (supraspinatus)Lift off test /Belly press(
subscapularis)
Accessory
tests (as required)
Scalf Test (ACJ)Neer, Hawkins and Kennedy (impingement)
Pal
pation for tenderness
As required
Shoulder Assessment
* Restriction = summary of
Cyriax’s “capsular pattern”Slide7
Standard tests
Observations
Deformity, wasting, heat, effusion, bony contours
Active movements
Neck x 6 (flex, ext, side flex and rot)
Shoulder (elevation, HBB, LR)Elbow: flex/ext, pronation/supinationWrist: flex/ext, RD/UDIs active range full? If not:Is the joint stiff?If the joint isn’t stiff, lost range may be due to weakness or pain.
Passive movementsEnd feel, crepitus, pain
Isometric actions
Screening tests
Extension
Flexion
Passive stretching
Combined elbow ext, wrist flex and pronation (stretches extensors)
Combined elbow ext, wrist ext and supination (
stretches flexors)
Accessory tests (as required)Pal
pation for tenderness
As required
Elbow Assessment