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Musculoskeletal Exam 2004-2005. Primary Care Sports Medicine Department of Family Practice Hennepin County Medical Center. Shoulder Bone and soft tissue anatomy (anterior view). A-C Joint. Acromion. Clavicle. Coracoid Process. Longhead of biceps tendon.
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Musculoskeletal Exam2004-2005 Primary Care Sports Medicine Department of Family Practice Hennepin County Medical Center
ShoulderBone and soft tissue anatomy (anterior view) A-C Joint Acromion Clavicle Coracoid Process Longhead of biceps tendon
ShoulderBone and soft tissue anatomy (lateral view) Clavicle A-C joint Spine of scapula Coracoid process Supraspinatus Insertion Infraspinatus Insertion Subscapular Insertion Greater tuberosity Teres Minor Insertion Lesser tuberosity
ShoulderBone and soft tissue anatomy (posterior view) Spine of scapula Scapula
Flexion 0 - 180° Extension 0 - 60° Abduction 0 - 180° Adduction 0 - 75° IR (add) 0 – 90º ER (add) 0 – 90º IR (abd) 0 – 90º ER (abd) 0 – 90º ShoulderRange of Motion
Combination ROM (extension, adduction, and internal rotation) ShoulderRange of motion
Supraspinatus (“empty-can” sign) Evaluate for strength and presence of pain. ShoulderStrength testing
Infraspinatus (resisted external rotation in adduction) Evaluate for strength and presence of pain. ShoulderStrength testing
Teres minor and infraspinatus (resisted external rotation in abduction) ShoulderStrength testing
Subscapularis (resisted internal rotation) Evaluate for strength and presence of pain. ShoulderStrength testing
Subscapularis (“belly press”) If the elbow ends in the adducted position, the subscapularis is weak. ShoulderStrength testing
Neer’s test Test is (+) if pain occurs. ShoulderImpingement tests
Hawkin’s tests Impingement Coracoid impingement Tests (+) if pain occurs. ShoulderImpingement tests
Anterior “Apprehension” test When (+) and accompanied by recent acute trauma, suggests anterior dislocation. ShoulderStability tests
Anterior Relocation test When (+), suggests chronic anterior instability. ShoulderStability tests
Anterior “Load and shift” test Up to 25% anterior translation is considered normal. ShoulderStability tests
Inferior “Sulcus sign” ShoulderStability tests
Shoulder – Sulcus sign With stress Without stress (+) sulcus sign
Posterior Apply axial load. ShoulderStability tests
Posterior “Load and shift” test Up to 25% posterior translation is considered normal. ShoulderStability tests
O’Brien’s test A positive test occurs when pain occurs only in the “thumb down” position. ShoulderTests for superior labral tears
Anterior slide test The test is (+) when pain or a “pop” or “click” occurs at the anterior-superior shoulder or if the maneuver reproduces the patient’s pain. ShoulderTests for superior labral tears
“Clunk” test The test is (+) if a “clunk” occurs or if the patient’s pain is reproduced. ShoulderTests for superior labral tears
Palpation ShoulderAcromioclavicular (AC) tests
Crossed adduction test The test is (+) if the process of adduction causes pain at the AC joint. ShoulderAcromioclavicular (AC) tests
Speed’s test Test is (+) if pain is reproduced at longhead of biceps in humeral groove. ShoulderLonghead of biceps test
Serratus anterior Test is positive if scapular “winging” exists. ShoulderScapular stabilizer tests
“Wall push” Test is (+) if scapular “winging” is observed. ShoulderScapular stabilizer tests
KneeBone and soft tissue anatomy (anterior) Right knee Patella Medial Collateral ligament Lateral Collateral ligament Medial joint line Patellar tendon Lateral joint line Tibial tubercle
KneeBone and soft tissue anatomy (medial) Right knee flexed to 90° Patella Tibial tubercle Medial femoral condyle Medial joint line MCL
KneeBone and soft tissue anatomy (lateral) Right knee flexed to 90° Patellar tendon Patella Lateral femoral condyle Lateral joint line LCL Fibula
Flexion 0 - 135° Extension 0 - 15° Int Rotation 0 – 20 to 30° Ext Rotation 0 – 30 to 40° KneeRange of motion
Valgus stress test Test performed at 30° of flexion. Note “end point” and if joint opens compared to uninvolved side. KneeTests of medial stability (MCL)
Varus stress test Test performed at 30° flexion. Note “end point” and if joint opens compared to uninvolved side. KneeTest of lateral stability (LCL)
Palpate for joint line tenderness. KneeTest for meniscal injury
McMurray’s test Note pain and/or “click” or subluxing meniscus. KneeTest for meniscal injury
Spring (“bounce”) test Test is (+) if pain occurs along joint line when knee “bounces” into extension. KneeTest for meniscal injury
Lachman’s test Note “end point” and or anterior translation of tibia. KneeTest for anterior stability (ACL)
Lachman’s test (modification) Kneetest for anterior stability (ACL)
Lachman’s test (Modification) KneeTest for anterior stability (ACL)
Anterior drawer Note anterior tibial translation and presence or absence of “end point”. KneeTests for anterior stability
Recurvatum test Presence of unilateral recurvatum suggests injury to posterolateral corner. KneeTests for posterior instability
Posterior sag KneeTests for posterior stability
Posterior drawer Note position of tibial plateau in relationship to lateral femoral condyle. KneeTests for posterior stability
Quadriceps active test Test is (+) if tibia translates in anterior direction when quadriceps contract. KneeTests for posterior stability
Patellar pseudocompression test Test is (+) if pain is present. KneePatellofemoral tests
Compression test Test is (+) if active contraction and compression cause pain. KneePatellofemoral tests
Palpate medial and lateral patellar facets. Tenderness along superior and medial aspect of patella may suggest medial plica syndrome. KneePatellofemoral tests
Patellar apprehension test Test is (+) if test causes pain and/or fear that patella might dislocate. KneeTest for patellar dislocation
ElbowBone and soft tissue anatomy (lateral view) Right elbow Lateral epicondyle Olecranon