evidence-based medicine is integration of best research evidence with clinical experience and patient values
what is the purpose of the examination
identify impairments, functional limitations, and develop a diagnosis
how accurate is a clinical examination in predicting rotator cuff pathology
physical exam and arthroscopic exam show 85% agreement with physical therapist
some reports suggest shoulder clinical exams include special test 91% sensitive, 75% specific
the examination consist of;
history
posture/observation
ROM
MMT
R/S
palpation
physical diagnostic test
medical imaging
true or false – the literature suggests that many of the objective methods for utilizedto evaluate shoulder posture are poorly described, demonstrating inconsistent reliability, and have limited evidence to suggest a relationship between shoulder pain and posture
true
what are some common postural test
Double Square Lat, Scapular SLide, and Lenne Test
true or false – the AMA and AAOS have different recommended values for range of motion
true
we should document toward our audience
what are the muscles that at a minimum must be tested in patients with suspected rotator cuff pathology
supraspinatus
infraspinatus
subscapularis
what are the scapular muscles that should be evaluated in a rotator cuff injury
serratus, middle trap, and lower trap
what are some common tests for the supraspinatus
empty can
full can
true or false – a drop arm test is basically a test to determine if a patient has an manual muscle test of greater or less than 3/5.
true
what is this test
Empty Can
this position is optimal for testing what muscle
infraspinatus
there is no sensitivity or specificity data
what is being examined in this picture
what is the purpose
external rotation lag sign
detecting supraspinatus and infraspinatus tears
what is this test called and what muscle does it assess
lift off test
subscapularis
true or false – the subscapularis is likely the first muscle to tear in the rotator cuff
true or false – A study performed by yoss found that 65% of the time diminished reflexes correlated with surgical findings in diminished sensation correlated 82% of the time.
false – Yoss found that 82% of the time diminished reflexes correlated with surgical findings and diminished sensation correlated 65% of the time
this position of the arm is used to palpate what muscle?
supraspinatus
this position of the arm is used palpate what muscle?
infraspinatus
patient is placed into extension and abduction, this is important during iontophoresis and phonophoresis
this position of the arm is used to palpate what muscle?
adductor to the side
subscapularis
this position of the arm is used to palpate what muscle?
long head of the biceps
what is the purpose of diagnostic tests
refine and focus examination
classification of disorders
selecting intervention
what are the characteristics of a good diagnostic test
has and intended use
has a well described physical performance
has a scoring criteria
should be performed on the proper population
name the five steps in testing selection
1. determine pretest diagnosis
2. identify purpose of special test – refine focus examination, classification, selecting intervention
3. Identify valid test that relate to your intended purpose- review the literature concerning the test that relate to your intended purpose – hard part
4. select test that rule in or rule out the disorder and that compliment each other
5. Whenever possible rely on likelihood ratios, they are the most powerful
what is this test
Neer - impingement sign
the impingement sign causes impingement between what two structures
greater tuberosity
acromion
what is this test called and what is a test
Hawkins
CA ligament impingement
what is the name of this test and what does it test
forced cross arm adduction
AC Joint impingement
the forced cross arm adduction impinges what two structures in the shoulder
GT/RRC on undersurface of the AC joint and compresses AC joint to elicit pain
what are some tests for testing the biceps tendon
yergason's
speeds
yocum
what is clustering
taking two or three tests that help determine a condition
what is the name of this test and what is being tested
sulcus sign
inferior stability of the shoulder
what is the name of this test and what is being tested
loaded and shift
anterior and posterior instability
what is being assessed in this picture
the posterior capsule ( joint play)
what is being assessed in this picture
inferior capsule
what test is this
apprehension sign
what is the name of this test
anterior release
also good for posterior instability
what is being assessed in this picture
MGHL Stability test
what is being assessed in this picture
The rotator cuff can be related to as a clock, SLAP lesions occur between ____?
10 - 2
the rotator cuff can be related to as a clock, bank heart lesions occur between _____?
2 - 6/7
what is the name of this test and what does it assess
O'Brien Test/active compression test
Slap Lesions
what is this test and what does is assessed
anterior slide test
slap lesion
what is the name of this test and what does it assess
crank test
slap/labral lesion
what is the name of this test and what is assess
clunk test
slap lesion
what are the important things to look for on an x-ray
use ABC's
joint space
eye brow signs
Hill Sachs/RHS
AC joint
acromion morphology –Type I, II, III
what are the indications for arthrography
weakness of external rotation
impingement
acute pain increase
LH biceps rupture
dislocation > 40 years
not used much anymore
Author
BPT
ID
66622
Card Set
quiz #2 – shoulder examination taking an evidence-based approach
Description
shoulder examination taking of an evidence-based approach
