Medical Tests for the Shoulder

Topics: Shoulder, Scapula, Humerus Pages: 8 (2213 words) Published: February 28, 2014
Jerk Test
~ The shoulder joint has three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. The head of the upper arm bone is usually much larger than the socket, and a soft fibrous tissue rim called the labrum surrounds the socket to help stabilize the joint. The rim deepens the socket by up to 50% so that the head of the upper arm bone fits better. In addition, it serves as an attachment site for several ligaments. ~Patient sits with the arm medially rotated and forward flexed to 90 deg ~Examiner grasps the patients elbow and axially loads the humerus in a proximal direction. While maintainin the axial loading, the examiner moves the arm horizontally (cross-flexion/horizontal adduction) across the body. ~Production of a sudden jerk or clunk as the humeral head slides off (sublaxes) the back of the glenoid. ~When the arm is returned to the original 90 deg. Abduction position, a 2nd jerk may be felt as the head reduces ~No jerk or clunk

Circumduction Test
~ The Shoulder Circumduction test is a simple test of shoulder flexibility. This test is part of the protocol for the Groningen Fitness Test for the Elderly. Another shoulder flexibility test designed for testing the elderly is the Back Scratch Test.

~Patient is in standing position. The examiner stands behind the patient grasping the patient’s forearm with the hand. ~The examiner begins circumduction by extending the patient’s arm while maintaining slight abduction. As the circumduction continues into elevation, the arm is brought over the top and into the flexed and adducted position. ~If the examiner palpates the posterior aspect of the patient’s shoulder as the arm moves downward in forward flexion and adduction, the humeral head will be felt to sublux posteriorly in a positive test, and the patient will say, “That’s what it feels like when it bothers me” ~Patient doesn’t feel bothered

Test for Inferior Shoulder Instability (Sulcus Sign)
~Rotator cuff muscles act to stabilize the shoulder.
~Also, ligaments and capsule provide static and dynamic stabilization of the glenohumeral joint. ~The insufficiency of these stabilizers lead to laxity of the joint causin an infierior instability. ~Patient stands with the arm by the side and shoulder muscles relaxed. ~Best position to test for inferior instability is at 20 deg – 50 deg of abduction with neutral rotation. Also, rotation will cause he capsule to tighten anteriorly (lateral rotation) or posteriorly (medial rotation), and the sulcus distance decreases. ~The examiner grasps the patient’s forearm below the elbow ad pulls the arm distally. ~Excessive inferior humeral head translation with a visible and/or palpable "step–off" or "sulcus" deformity immediately inferior to the acromion AND/OR ~Pain and/or movement of the scapula inferior to the clavicle ~Patient follows downward movement of the arm

~(+) indication for inferior and/or multidirectional instability ~(+) indication for acromioclavicular and/or coracoclavicular ligament sprain and inferior instability

~No translation or pain


Feagin Test
~ In a healthy shoulder, the head of the Humerus is stabilized within the Glenoid fossa (Glenohumeral joint) through multiple structures including (from the inside out) the Labrum, Glenohumeral ligaments, joint capsule, and Rotator Cuff muscles. ~ If there is damage or weakness in any of the stabilizing structures, the integrity of the Glenohumeral joint can be compromised ~ The purpose of the stabilizing structures is to keep the head of the Humerus safely within the boundaries of the Glenoid fossa while the arm is in motion ~The patient stands with the armabducted to 90 de and the examiner’s...
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