[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.00,0:00:02.50,Default,,0000,0000,0000,,(English captions by Andrea Matsumoto from\Nthe University of Michigan)
Dialogue: 0,0:00:03.10,0:00:07.35,Default,,0000,0000,0000,,To ensure a thorough assessment it is best\Nto perform the musculoskeletal exam of the
Dialogue: 0,0:00:07.35,0:00:09.16,Default,,0000,0000,0000,,shoulder in a systematic way.
Dialogue: 0,0:00:09.16,0:00:12.93,Default,,0000,0000,0000,,The following is a suggested order of exam\Nthat incorporates the common techniques for
Dialogue: 0,0:00:12.93,0:00:17.10,Default,,0000,0000,0000,,diagnosing shoulder injuries.
Dialogue: 0,0:00:17.10,0:00:19.63,Default,,0000,0000,0000,,The shoulder exam begins with inspection.
Dialogue: 0,0:00:19.63,0:00:25.38,Default,,0000,0000,0000,,In an anterior view assess the shoulders for\Nasymmetry, clavicle deformity, muscular atrophy,
Dialogue: 0,0:00:25.38,0:00:26.87,Default,,0000,0000,0000,,or skin changes.
Dialogue: 0,0:00:26.87,0:00:30.86,Default,,0000,0000,0000,,In a posterior view assess for the same.
Dialogue: 0,0:00:30.86,0:00:33.20,Default,,0000,0000,0000,,Next evaluate for active range of motion.
Dialogue: 0,0:00:33.20,0:00:36.79,Default,,0000,0000,0000,,If pain or limitation exists, repeat the motion\Npassively.
Dialogue: 0,0:00:36.79,0:00:41.80,Default,,0000,0000,0000,,To rule out cervical causes of referred shoulder\Npain, evaluate neck range of motion: flexion,
Dialogue: 0,0:00:41.80,0:00:45.99,Default,,0000,0000,0000,,extension, lateral flexion, and rotation.
Dialogue: 0,0:00:45.99,0:00:57.24,Default,,0000,0000,0000,,Next evaluate active range of motion of the\Nshoulders: flexion, extension, abduction,
Dialogue: 0,0:00:57.24,0:01:03.46,Default,,0000,0000,0000,,adduction, external rotation, and internal\Nrotation.
Dialogue: 0,0:01:03.46,0:01:08.91,Default,,0000,0000,0000,,From the posterior view we can further assess\Nthe combined adduction and external rotation
Dialogue: 0,0:01:08.91,0:01:12.02,Default,,0000,0000,0000,,with Apley scratch test of external rotation.
Dialogue: 0,0:01:12.02,0:01:15.13,Default,,0000,0000,0000,,Have the patient reach overhead and down the\Nspine.
Dialogue: 0,0:01:15.13,0:01:22.13,Default,,0000,0000,0000,,Most patients can reach past C7.
Dialogue: 0,0:01:25.27,0:01:29.66,Default,,0000,0000,0000,,Combine adduction and internal rotation with\Nthe Apley scratch test of internal rotation.
Dialogue: 0,0:01:29.66,0:01:32.43,Default,,0000,0000,0000,,Have the patient reach behind the back and\Nup the spine.
Dialogue: 0,0:01:32.43,0:01:36.26,Default,,0000,0000,0000,,Most patients can reach to T7 or the lower\Nborder of the scapula.
Dialogue: 0,0:01:36.26,0:01:39.13,Default,,0000,0000,0000,,Next assess the strength of the rotator cuff\Nmuscles.
Dialogue: 0,0:01:39.13,0:01:42.89,Default,,0000,0000,0000,,The drop arm test evaluates for a supraspinatus\Nmuscle tear.
Dialogue: 0,0:01:42.89,0:01:47.90,Default,,0000,0000,0000,,Passively adduct the shoulder to 90 degrees,\Nflex to 30 degrees, and point thumbs down.
Dialogue: 0,0:01:47.90,0:01:53.30,Default,,0000,0000,0000,,The test is positive if the patient is unable\Nto keep arms elevated after the examiner releases.
Dialogue: 0,0:01:53.30,0:01:57.19,Default,,0000,0000,0000,,Supraspinatus muscle strength testing can\Nalso be done using the empty can test.
Dialogue: 0,0:01:57.19,0:02:01.10,Default,,0000,0000,0000,,In this same position provide resistance as\Nthe patient lifts upward.
Dialogue: 0,0:02:01.10,0:02:04.49,Default,,0000,0000,0000,,Pain suggests possible tendinopathy or tear.
Dialogue: 0,0:02:04.49,0:02:08.70,Default,,0000,0000,0000,,Infraspinatus and teres minor muscle strength\Nis tested with resisted external rotation.
Dialogue: 0,0:02:08.70,0:02:11.91,Default,,0000,0000,0000,,Pain or weakness suggests a possibly tendinopathy\Nor tear.
Dialogue: 0,0:02:11.91,0:02:18.33,Default,,0000,0000,0000,,Subscapularis muscle strength can be tested\Nwith resisted internal rotation.
Dialogue: 0,0:02:18.33,0:02:22.33,Default,,0000,0000,0000,,Subscapularis muscle strength is also tested\Nwith the push-off test.
Dialogue: 0,0:02:22.33,0:02:26.17,Default,,0000,0000,0000,,Have the patient adduct the arm and internally\Nrotate behind their back.
Dialogue: 0,0:02:26.17,0:02:30.03,Default,,0000,0000,0000,,Provide resistance as the patient pushes their\Narm away from the body.
Dialogue: 0,0:02:30.03,0:02:33.33,Default,,0000,0000,0000,,Pain or weakness suggests tendinopathy or\Ntear.
Dialogue: 0,0:02:33.33,0:02:36.34,Default,,0000,0000,0000,,Next palpate anatomic landmarks for tenderness.
Dialogue: 0,0:02:36.34,0:02:46.50,Default,,0000,0000,0000,,The suprasternal notch, the sternal clavicular\Njoint, along the clavicle, the AC joint, the
Dialogue: 0,0:02:46.50,0:02:57.04,Default,,0000,0000,0000,,acromion, the greater tubercle of the humerus,\Nthe lesser tubercle of the humerus, the
Dialogue: 0,0:02:57.04,0:03:01.18,Default,,0000,0000,0000,,long head of the biceps which runs between\Nthe greater and lesser trochanter, and as
Dialogue: 0,0:03:01.18,0:03:08.00,Default,,0000,0000,0000,,you internally and externally rotate you can\Nfeel that, and the coracoid.
Dialogue: 0,0:03:08.00,0:03:15.79,Default,,0000,0000,0000,,Posteriorly look at acromion, the scapular\Nspine, the supraspinatus muscle above the
Dialogue: 0,0:03:15.79,0:03:28.52,Default,,0000,0000,0000,,spine, the infraspinatus below the spine,\Nteres minor muscle, the trapezius muscle,
Dialogue: 0,0:03:28.52,0:03:34.95,Default,,0000,0000,0000,,the rhomboid muscle, and look for scapular\Nthoracic articulation, particularly looking
Dialogue: 0,0:03:34.95,0:03:37.49,Default,,0000,0000,0000,,for winged scapula.
Dialogue: 0,0:03:37.49,0:03:42.13,Default,,0000,0000,0000,,Specific testing of the shoulder to evaluate\Nfor injuries may include but is not limited
Dialogue: 0,0:03:42.13,0:03:43.93,Default,,0000,0000,0000,,to the following tests.
Dialogue: 0,0:03:43.93,0:03:47.60,Default,,0000,0000,0000,,Hawkin's test assesses for possible rotator\Ncuff impingement.
Dialogue: 0,0:03:47.60,0:03:53.48,Default,,0000,0000,0000,,Stabilize the scapula, passively abduct the\Nshoulder to 90 degrees, flex the shoulder
Dialogue: 0,0:03:53.48,0:03:58.79,Default,,0000,0000,0000,,to 30 degrees, and flex the elbow to 90 degrees,\Nand internally rotate the shoulder.
Dialogue: 0,0:03:58.79,0:03:59.46,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:03:59.46,0:04:05.17,Default,,0000,0000,0000,,Neer's test also assesses for possible rotator\Ncuff impingement.
Dialogue: 0,0:04:05.17,0:04:09.77,Default,,0000,0000,0000,,Stabilize the scapula and with the thumb pointing\Ndown passively flex the arm.
Dialogue: 0,0:04:09.77,0:04:11.56,Default,,0000,0000,0000,,Pain is a positive test.
Dialogue: 0,0:04:11.56,0:04:17.31,Default,,0000,0000,0000,,The cross arm flexion test also evaluates\Nfor acromioclavicular arthritis or subluxation.
Dialogue: 0,0:04:17.31,0:04:20.85,Default,,0000,0000,0000,,Flex the shoulder to 90 degrees and adduct\Nacross body.
Dialogue: 0,0:04:20.85,0:04:25.13,Default,,0000,0000,0000,,Pain at the acromioclavicular joint is a positive\Ntest.
Dialogue: 0,0:04:25.13,0:04:29.21,Default,,0000,0000,0000,,There are several tests to evaluate for shoulder\Ninstability.
Dialogue: 0,0:04:29.21,0:04:33.80,Default,,0000,0000,0000,,To test inferior glenohumeral stability place\Ntraction on the humerus with the arm at the
Dialogue: 0,0:04:33.80,0:04:34.64,Default,,0000,0000,0000,,patient's side.
Dialogue: 0,0:04:34.64,0:04:39.36,Default,,0000,0000,0000,,If a gap greater than 1cm appears between\Nthe humoral head and the undersurface of the
Dialogue: 0,0:04:39.36,0:04:45.45,Default,,0000,0000,0000,,acromion it is considered a positive sulcus\Nsign with inferior instability.
Dialogue: 0,0:04:45.45,0:04:50.43,Default,,0000,0000,0000,,The load and shift test evaluates for anterior\Nand posterior glenohumeral stability.
Dialogue: 0,0:04:50.43,0:04:54.100,Default,,0000,0000,0000,,Provide an axial load on the humerus compressing\Nthe glenohumeral joint, then move the humeral
Dialogue: 0,0:04:54.100,0:04:58.11,Default,,0000,0000,0000,,head anteriorly and posteriorly.
Dialogue: 0,0:04:58.11,0:05:02.61,Default,,0000,0000,0000,,Anterior or posterior displacement is positive\Nfor instability.
Dialogue: 0,0:05:02.61,0:05:07.23,Default,,0000,0000,0000,,The apprehension and relocation tests also\Nevaluate for anterior glenohumeral stability.
Dialogue: 0,0:05:07.23,0:05:12.86,Default,,0000,0000,0000,,With the patient supine, abduct shoulder to\N90 degrees and externally rotate the arm to
Dialogue: 0,0:05:12.86,0:05:15.39,Default,,0000,0000,0000,,place stress on the glenohumeral joint.
Dialogue: 0,0:05:15.39,0:05:20.87,Default,,0000,0000,0000,,If the patient feels apprehensive that the arm\Nmay dislocate it is a positive apprehension arm.
Dialogue: 0,0:05:20.87,0:05:25.57,Default,,0000,0000,0000,,The relocation test is performed using the\Nexaminer's hand to place a posteriorly directed
Dialogue: 0,0:05:25.57,0:05:27.73,Default,,0000,0000,0000,,force on the glenohumeral joint.
Dialogue: 0,0:05:27.73,0:05:30.62,Default,,0000,0000,0000,,Relief of apprehension is a positive test.
Dialogue: 0,0:05:30.62,0:05:35.66,Default,,0000,0000,0000,,There are several tests that assess for injuries\Nof the biceps tendon and glenohumeral labrum.
Dialogue: 0,0:05:35.66,0:05:40.61,Default,,0000,0000,0000,,To perform a Speed's test flex the shoulder\Nto 90 degrees with the arm supinated.
Dialogue: 0,0:05:40.61,0:05:43.62,Default,,0000,0000,0000,,Provide downward resistance against the shoulder\Nflexion.
Dialogue: 0,0:05:43.62,0:05:50.24,Default,,0000,0000,0000,,Pain indicates possibly bicepital tendon\Nor labral tear.
Dialogue: 0,0:05:50.24,0:05:54.100,Default,,0000,0000,0000,,To perform Yergason's test flex elbow to\N90 degrees, shake hands with patient and provide
Dialogue: 0,0:05:54.100,0:05:57.45,Default,,0000,0000,0000,,resistance against supination.
Dialogue: 0,0:05:57.45,0:06:02.83,Default,,0000,0000,0000,,Pain indicates a possible bicepital tendon\Nor associated labral tear.
Dialogue: 0,0:06:02.83,0:06:07.23,Default,,0000,0000,0000,,To perform O'Brien's Test point the thumb\Ndown and flex shoulder to 90 degrees.
Dialogue: 0,0:06:07.23,0:06:12.92,Default,,0000,0000,0000,,Adduct the arm across midline, provide resistance\Nagainst further shoulder flexion and evaluate
Dialogue: 0,0:06:12.92,0:06:14.77,Default,,0000,0000,0000,,for pain.
Dialogue: 0,0:06:14.77,0:06:18.89,Default,,0000,0000,0000,,Repeat with the thumb pointing up and again\Nevaluate for pain.
Dialogue: 0,0:06:18.89,0:06:22.94,Default,,0000,0000,0000,,If pain was present with the thumb down but\Nrelieved with the thumb up, it is considered
Dialogue: 0,0:06:22.94,0:06:27.17,Default,,0000,0000,0000,,a positive test, suspicious for labral tear.
Dialogue: 0,0:06:27.17,0:06:33.86,Default,,0000,0000,0000,,To perform the Biceps Load Test supinate the\Narm, abduct shoulder to 90 degrees, and flex
Dialogue: 0,0:06:33.86,0:06:35.76,Default,,0000,0000,0000,,elbow to 90 degrees.
Dialogue: 0,0:06:35.76,0:06:41.71,Default,,0000,0000,0000,,Externally rotate the arm until patient becomes\Napprehensive and provide resistance against
Dialogue: 0,0:06:41.71,0:06:44.09,Default,,0000,0000,0000,,elbow flexion.
Dialogue: 0,0:06:44.09,0:06:50.44,Default,,0000,0000,0000,,Pain indicates possible bicepital tendonopathy\Nor associated labral tear.
Dialogue: 0,0:06:50.44,0:06:56.80,Default,,0000,0000,0000,,To perform the Biceps Tension Test supinate\Nthe arm, abduct shoulder to 90 degrees, flex
Dialogue: 0,0:06:56.80,0:07:02.79,Default,,0000,0000,0000,,elbow to 90 degrees, and externally rotate\Narm until patient becomes apprehensive and
Dialogue: 0,0:07:02.79,0:07:04.81,Default,,0000,0000,0000,,pronate arm.
Dialogue: 0,0:07:04.81,0:07:10.59,Default,,0000,0000,0000,,Pain indicates possible bicepital tendonopathy\Nor associated labral tear.
Dialogue: 0,0:07:10.59,0:07:14.41,Default,,0000,0000,0000,,To perform the Crank Test, fully abduct the\Nshoulder and provide an axial load on the
Dialogue: 0,0:07:14.41,0:07:15.94,Default,,0000,0000,0000,,humerus.
Dialogue: 0,0:07:15.94,0:07:17.51,Default,,0000,0000,0000,,Internally and externally rotate the arm.
Dialogue: 0,0:07:17.51,0:07:25.16,Default,,0000,0000,0000,,Pain, catching, or painful clicking is considered\Na positive test suggestive of a labral tear.
Dialogue: 0,0:07:27.80,0:07:32.22,Default,,0000,0000,0000,,There are several tests to evaluate for thoracic\Noutlet syndrome as a cause for the patient's
Dialogue: 0,0:07:32.22,0:07:34.30,Default,,0000,0000,0000,,shoulder pain.
Dialogue: 0,0:07:34.30,0:07:39.46,Default,,0000,0000,0000,,To perform the Costoclavicular Maneuver draw\Nthe patient's shoulders inferiorly and posteriorly.
Dialogue: 0,0:07:39.46,0:07:45.31,Default,,0000,0000,0000,,If patient has reproduction of arm pain or\Nnumbness, consider thoracic outlet syndrome.
Dialogue: 0,0:07:45.31,0:07:50.44,Default,,0000,0000,0000,,To perform Roos' Test abduct the shoulder\Nto 90 degrees, flex elbow to 90 degrees, and
Dialogue: 0,0:07:50.44,0:07:53.67,Default,,0000,0000,0000,,rapidly open and close hands for up to 3 minutes.
Dialogue: 0,0:07:53.67,0:07:59.52,Default,,0000,0000,0000,,If the patient has reproduction of pain or\Nnumbness, consider thoracic outlet syndrome.
Dialogue: 0,0:07:59.52,0:08:02.63,Default,,0000,0000,0000,,To perform Adson's Test locate the radial\Npulse.
Dialogue: 0,0:08:02.63,0:08:07.20,Default,,0000,0000,0000,,Have the patient take a deep breath and extend\Nneck, and rotate head towards the painful
Dialogue: 0,0:08:07.20,0:08:07.97,Default,,0000,0000,0000,,shoulder.
Dialogue: 0,0:08:07.97,0:08:12.44,Default,,0000,0000,0000,,If radial pulse diminishes on the affected\Nside, it is considered a positive test suspicious
Dialogue: 0,0:08:12.44,0:08:15.91,Default,,0000,0000,0000,,for thoracic outlet syndrome.
Dialogue: 0,0:08:15.91,0:08:20.79,Default,,0000,0000,0000,,Spurling's Test evaluates for cervical root\Nimpingement.
Dialogue: 0,0:08:20.79,0:08:25.08,Default,,0000,0000,0000,,With the head extended and rotated toward\Nthe painful shoulder, apply an axial load
Dialogue: 0,0:08:25.08,0:08:27.33,Default,,0000,0000,0000,,to the cervical spine.
Dialogue: 0,0:08:27.33,0:08:32.33,Default,,0000,0000,0000,,Reproduction of pain or paresthesias with\Nthis maneuver is a positive test.
Dialogue: 0,0:08:35.97,0:08:39.66,Default,,0000,0000,0000,,In concluding the shoulder exam it is important\Nto document a neurovascular exam.
Dialogue: 0,0:08:39.66,0:08:42.12,Default,,0000,0000,0000,,Here we demonstrate a brief exam.
Dialogue: 0,0:08:42.12,0:08:47.39,Default,,0000,0000,0000,,Resisted wrist extension tests the radial\Nnerve.
Dialogue: 0,0:08:47.39,0:08:52.83,Default,,0000,0000,0000,,Resisted opposition of the thumb tests the\Nmedian nerve.
Dialogue: 0,0:08:52.83,0:08:58.56,Default,,0000,0000,0000,,Resisted digit abduction tests the ulnar nerve.
Dialogue: 0,0:08:58.56,0:09:03.21,Default,,0000,0000,0000,,Radial artery pulse and capillary refill testing.
Dialogue: 0,0:09:03.21,0:09:05.70,Default,,0000,0000,0000,,Further neurologic or vascular exam may be\Nindicated by history.
Dialogue: 0,0:09:05.70,0:09:06.99,Default,,0000,0000,0000,,Acknowledgement: The Japanese translation of this video was made as part of Shizuoka-University of Michigan Advanced Residency Training, Education and Research in Family Medicine (SMARTER FM) Project supported by Shizuoka Prefecture and funded by the Community Healthcare Revival Fund.