quiz #2 – shoulder examination taking an evidence-based approach

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BPT
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66622
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quiz #2 – shoulder examination taking an evidence-based approach
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2011-02-16 10:51:06
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orthopedics
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shoulder examination taking of an evidence-based approach
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  1. what is evidence-based medicine
    evidence-based medicine is integration of best research evidence with clinical experience and patient values
  2. what is the purpose of the examination
    identify impairments, functional limitations, and develop a diagnosis
  3. 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
  4. the examination consist of;
    • history
    • posture/observation
    • ROM
    • MMT
    • R/S
    • palpation
    • physical diagnostic test
    • medical imaging
  5. 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
  6. what are some common postural test
    Double Square Lat, Scapular SLide, and Lenne Test
  7. true or false – the AMA and AAOS have different recommended values for range of motion
    true

    we should document toward our audience
  8. what are the muscles that at a minimum must be tested in patients with suspected rotator cuff pathology
    • supraspinatus
    • infraspinatus
    • subscapularis
  9. what are the scapular muscles that should be evaluated in a rotator cuff injury
    serratus, middle trap, and lower trap
  10. what are some common tests for the supraspinatus
    • empty can
    • full can
  11. 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
  12. what is this test
    Empty Can
  13. this position is optimal for testing what muscle
    • infraspinatus
    • there is no sensitivity or specificity data
  14. what is being examined in this picture

    what is the purpose
    external rotation lag sign

    detecting supraspinatus and infraspinatus tears
  15. what is this test called and what muscle does it assess
    • lift off test
    • subscapularis
  16. true or false – the subscapularis is likely the first muscle to tear in the rotator cuff
    false – most likely the very last muscle to tear
  17. what is this picture assessing
    • internal rotation lag sign
    • detecting subscapularis ruptures – massive rotator cuff tears
  18. 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
  19. this position of the arm is used to palpate what muscle?
    supraspinatus
  20. 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
  21. this position of the arm is used to palpate what muscle?

    adductor to the side
    subscapularis
  22. this position of the arm is used to palpate what muscle?
    long head of the biceps
  23. what is the purpose of diagnostic tests
    • refine and focus examination
    • classification of disorders
    • selecting intervention
  24. 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
  25. 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
  26. what is this test
    Neer - impingement sign
  27. the impingement sign causes impingement between what two structures
    • greater tuberosity
    • acromion
  28. what is this test called and what is a test
    • Hawkins
    • CA ligament impingement
  29. what is the name of this test and what does it test
    • forced cross arm adduction
    • AC Joint impingement
  30. 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
  31. what are some tests for testing the biceps tendon
    • yergason's
    • speeds
    • yocum
  32. what is clustering
    taking two or three tests that help determine a condition
  33. what is the name of this test and what is being tested
    • sulcus sign
    • inferior stability of the shoulder
  34. what is the name of this test and what is being tested
    • loaded and shift
    • anterior and posterior instability
  35. what is being assessed in this picture
    the posterior capsule ( joint play)
  36. what is being assessed in this picture
    inferior capsule
  37. what test is this

    apprehension sign
  38. what is the name of this test
    • anterior release
    • also good for posterior instability
  39. what is being assessed in this picture
    MGHL Stability test
  40. what is being assessed in this picture
  41. The rotator cuff can be related to as a clock, SLAP lesions occur between ____?
    10 - 2
  42. the rotator cuff can be related to as a clock, bank heart lesions occur between _____?
    2 - 6/7
  43. what is the name of this test and what does it assess
    • O'Brien Test/active compression test
    • Slap Lesions
  44. what is this test and what does is assessed
    • anterior slide test
    • slap lesion
  45. what is the name of this test and what does it assess
    • crank test
    • slap/labral lesion
  46. what is the name of this test and what is assess
    • clunk test
    • slap lesion
  47. 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
  48. what are the indications for arthrography
    • weakness of external rotation
    • impingement
    • acute pain increase
    • LH biceps rupture
    • dislocation > 40 years
    • not used much anymore

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