Kinesiology Practicum #2
What are the three types of pinch tests?
- Lateral Pinch - 3-Point Pinch - Tip Pinch (2-Point Pinch) -Document the patient's score on 3 trials and find the SD . -DOCUMENT IN lbs -THE NUMBERS SHOULD BE FACING DOWN SO PT. DOES NOT SEE {in clinic: alternate between L and R hand and record BOTH} [we can use a calculator on our phone to average the numbers]
Shoulder: FLEXION (0-180º) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Anterior deltoid -Pt Position: Sitting edge of table w/arm flexed up to 90 degrees -Therapist Position: Stand at test side 5-4/5 R: over distal humerus while other hand stabilizes shoulder -Palpation: Palpate ant. deltoid lat. to axilla, but when testing 2/5 or less its superiorly and anterior surfaces of deltoid over shoulder joint -Instructions to Pt.: -raise arm forward to shoulder height. Hold it. Don't let me push down. -try raising arm -Goniometer: (0-180°) LAYING SUPINE Ax: humeral head SA: trunk MA: Lat. epicondyle -if > 90 degrees it's a 2/5 or less -Addt'l Comments: Grade 2/5: Partial ROM
Elbow: FLEXION (0-150°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Brachialis -Pt Position: -Sitting w/arms at sides -Biceps: palm up -Brachialis: palm out -Brachioradialis: thumbs up -Therapist Position: Stand in front of pt. R: Volar (flexor) forearm proximal to wrist Other hand applies pressure on shoulder 2/5: shoulder ABD 90°; cradle elbow. Forearm is supinated (biceps), pronated (brachialis), and midposition (brachioradialis) 1/5 supine at test side -Palpation: Biceps: antecubital space Brachialis: distal arm medial to biceps Brachioradials: lateral border of cubital fossa of neutral forearm -Instructions to Pt.: -Bend your elbow. Hold. Don't let me pull it down. -2/5 Try to bend your elbow -Goniometer: SUPINE w/towel under humerus Ax: lat. Epicondyle SA: shaft humerus MA: shaft of radius *arm supinated and flexed to measure: 0°-145° AROM -Addt'l Comments: Grade 2/5: full ROM Grade 1/5: pt SUPINE
Wrist: EXTENSION (0-70°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Extensor carpi radialis longus -Pt Position: Sitting w/arm pronated 2/5: neutral arm + ulnar side of hand on table 1/5: pronated on table (palm dwn) -Therapist Position: Sitting across table in front of pt. Support pt's forearm under wrist R: over dorsal MCPs 2/5: hold forearm to reduce friction -Palpation: 1/5: palpate for tendons separately -Instructions to Pt.: -Bring your wrist up. Hold. Don't let me push down. -2/5: Bend your wrist back -Goniometer: Use the small one! Pt. sitting w/hand on table pronated Ax: ulnar styloid SA: lat. Epicondyle MA: #5 Metacarpal -Addt'l Comments: Grade 2/5: full ROM "Bring wrist up/in or out" to test radial + ulnar sides
Wrist: FLEXION (0-80°) (MMT & Goni) -Primary Muscle (s): -Pt Position: -Therapist Position: -Palpation: -Instructions to Pt.: -Goniometer: -Addt'l Comments:
-Primary Muscle (s): Flexor carpi radialis, Flexor carpi ulnaris (two heads) -Pt Position: Sitting w/arm supinated, neutral wrist 2/5: neutral arm + ulnar side of hand on table -Therapist Position: Sitting across table in front of pt. Support pt's forearm under wrist R: to palm w/four fingers downward 2/5: hold forearm to reduce friction -Palpation: 1/5: forearm supinated on table. Palpate for flexor carpi tendons separately -Instructions to Pt.: -Bend your wrist. Hold. Don't let me pull it down. Keep your fingers relaxed -2/5: Bend your wrist, keeping fingers relaxed. -Goniometer: Pt. sitting w/hand on table, arm on wedge. Ax: SA: in contact w/the dorsal forearm MA: top of #3rd MCP joint
Shoulder: External Rotation (0-90°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Infraspinatus -Pt Position: Prone w/head toward test side. Shoulder 90°ABD w/towel under distal humerus. Forearm hanging -Therapist Position: Stand at test side. R: w/2 fingers on volar forearm above wrist (down + forward) Other arm: counterforce at elbow -For 2/5: Pt. laying with axilla at table edge, arm hanging. -Palpation: Palpate infraspinatus -Instructions to Pt.: -Raise your arm to level of table, fingers facing up. Hold. Don't let me... -Turn thumbs out -Goniometer: (0-90°) SUPINE arm on towel Ax: olecranon SA: perp. to trunk (pointing to floor) MA: shaft of ulna **Document Ex: 0°-73° AROM 0°-90° PROM -Addt'l Comments: Grade 2/5: Reposition so armpit is at table edge "turn thumbs out (ext rot)
Shoulder: ABDUCTION (0-180º) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Middle deltoid -Pt Position: Sitting w/arm ABD out at side up to 90 degrees for MMT -Therapist Position: -For 5-3/5, Behind pt w resistance over distal humerus and other arm stabilizing shoulder @ supraspinatus -For 2/5 just palpate & for 1/5 cradle elbow while palpating -Palpation: Support deltoid until 2/5 then palpate deltoid lat. to acromion process. -Instructions to Pt.: -lift arm out to side at shoulder level. Hold. Don't let me push down. 1/5-try hold arm this position/ to side. -Goniometer: (0-180°) SUPINE Ax: line up w/sternum to humeral head SA: ASIS MA: lateral epicondyle -Addt'l Comments: Grade 2/5: Partial ROM
Shoulder: Horizontal ADDUCTION (0-45º) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Pectoralis major -Pt Position: Prone w/ shoulder + elbow ABD at 90° (arm hanging) -Therapist Position: -Stand at test side R: at distal humerus. -Behind pt on test side for 2/5 or less and stabilize w one hand on superior shoulder and other palpating post. deltoid -Palpation: palpate posterior deltoid -Instructions to Pt.: -lift elbow up to ceiling. Hold. Don't let me push it down -Goniometer: (0-135°) SITTING IN CHAIR Cradle elbow at 90° shoulder flexion Ax: Acromion SA: neck MA: Lat epicondyle -Addt'l Comments: Grade 2/5: Full ROM Pt is SITTING beside plinth at axilla level + gravity eliminated.
Shoulder: Horizontal ABDUCTION (0-45º) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Posterior deltoid -Pt Position: Prone w/ shoulder + elbow ABD at 90° (arm hanging) -Therapist Position: -Stand at test side R: at distal humerus -Behind pt on test side for 2/5 or less and stabilize w one hand on superior shoulder and other palpating post. deltoid -Palpation: palpate posterior deltoid -Instructions to Pt.: -lift elbow up to ceiling. Hold. Don't let me push it down -try slide arm backwards -Goniometer: (0-45°) SITTING IN CHAIR Cradle elbow at 90° shoulder flexion Ax: Acromion SA: neck MA: Lat epicondyle -Addt'l Comments: Grade 2/5: Full ROM. Pt is SITTING beside plinth at axilla level + gravity eliminated.
Shoulder: EXTENSION (0-60º) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Posterior deltoid -Pt Position: Prone w/arms at side + palms up -Therapist Position: Stand at test side, R: distal humerus -Palpation: Posterior deltoid. Teres major (lateral border or scapula below axilla). -Instructions to Pt.: Lift arm high as can. Hold it. Don't let me push down. -Goniometer: (0-60°) PRONE Axis- humeral head Stable Arm- trunk Moveable Arm-Lateral epicondyle -if > 20 degrees it's a 2/5 or less -Addt'l Comments: Grade 2/5: Partial ROM
Forearm: PRONATION (0-80°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Pronator Teres -Pt Position: Sitting w/arms at side + elbow flex 90°, forearm in full supination -Therapist Position: Stand in front of pt, handshake w/2 fingers to lock wrist out. Support elbow with other hand. 2/5: beside or behind pt; cup elbow 1/5: beside or behind pt; support forearm -Palpation: Medial epicondyle -Instructions to Pt.: Turn your palm down. Hold. Don't let me turn it up. -2/5: bring thumb up to shoulder. Turn your palm away from face. -1/5: try to turn palm down -Goniometer: SITTING w/arm and elbow (flexed 90*) against ribs. Ax: 3rd MCP SA: point to floor MA: parallel to pen -Addt'l Comments: Grade 2/5: full ROM w/princess wave
Shoulder: Internal Rotation (0-70°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Subscapularis -Pt Position: Prone w/head toward test side. Shoulder 90°ABD w/towel under distal humerus. Forearm hanging -Therapist Position: Stand at test side. R: volar forearm above wrist (down + forward) Other arm: counterforce at elbow -For 2/5: Pt. laying at edge of table. -Palpation: Palpate 1/5 for subscapularis deep in axillary groove -Instructions to Pt.: -Move forearm up + back (palm toward sky). Hold. Don't let me push down. -Turn your arm so your palm faces away from the table... -goni. PROM: I'm going to go up further, tell if hurts" -Goniometer: (0-70°) SUPINE arm on towel Ax: olecranon SA: perp. to trunk (pointing to floor) MA: shaft of ulna **Document Ex: 0°-52° AROM 0°-68° PROM -Addt'l Comments: Grade 2/5: full ROM. Support hand to eliminate friction. Turn palms out (internal rotation)
Forearm: SUPINATION (0-80°) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Supinator & Biceps brachii (both heads) -Pt Position: -Sitting w/arms at side + elbow flex 90°, forearm in full pronation -2/5: pt. elbow flexed, thumb toward shoulder, -1/5 arm at same position for 3/5 -Therapist Position: Stand in front of pt, handshake w/2 fingers to lock wrist out. Other hand support elbow. 2/5: beside or behind pt; cup elbow 1/5: beside or behind pt; support forearm -Palpation: 1/5 deep for supinator near bicipital aponeurosis -Instructions to Pt.: -Turn your palm up. Hold. Don't let me turn it down. -2/5: bring thumb up to shoulder. Turn your palm toward your face. -1/5: try to turn palm to ceiling -Goniometer: SITTING w/arm and elbow (flexed 90*) against ribs. Ax: 3rd MCP SA: point to floor MA: parallel to pen -Addt'l Comments: Grade 2/5: full ROM w/princess wave
Elbow: EXTENSION (150 - 0⁰) (MMT & Goni) -Primary Muscle (s) -Pt Position -Therapist Position -Palpation -Instructions to Pt. -Goniometer -Addt'l Comments
-Primary Muscle (s): Triceps Brachii -Pt Position: Prone w/90° shoulder abd. + elbow flex w/arm hanging -2/5 Sitting, 90° shoulder abd. + 45° elbow flex; limb horizontal to floor. -Therapist Position: Stand at test side. Support the elbow at distal humerus. R: dorsal forearm (down) 2/5: cradle elbow or forearm 1/5: cradle forearm + palpate triceps -Palpation: Triceps near olecranon. Feeling for clicks. -Instructions to Pt.: Straighten elbow. Hold. Don't let me bend it. -2/5 try to straighten your elbow -Goniometer: SUPINE w/towel under humerus Ax: lat. Epicondyle SA: shaft humerus MA: shaft of radius *arm supinated and extended to measure: -145° - 0° AROM -Addt'l Comments: Grade 2/5: full ROM
Radial deviation (0-20º) (GONI ONLY)
Degrees: 0-20° Position: SITTING with hand on table pronated Points of Reference: •Axis: capitate (hole in dorsal hand) •Stable Arm: lateral epicondyle (midline of forearm) •Moveable Arm: 3rd MCP joint
Ulnar deviation (0-30º) (GONI ONLY)
Degrees: 0-30° Position: SITTING with hand on table pronated Points of Reference: •Axis: capitate (hole in dorsal hand) •Stable Arm: lateral epicondyle (midline of forearm) •Moveable Arm: 3rd MCP joint
Grip Dynamometer (right or left)
Document the patient's score on 3 trials and find the SD -pt. is to be seated and have elbow at side and then squeeze -Make sure to record the number in lbs [we can use a calculator on our phone to average the numbers] {in clinic: alternate between L and R hand and record BOTH}
Index, Middle, Ring, and 5th digit ROM: PIP
Index, middle, ring, and 5th digit: (0-110º)
Index, Middle, Ring, and 5th digit ROM: DIP
Index, middle, ring, and 5th digit: (0-65º)
Index, Middle, Ring, and 5th digit ROM: MCP
Index, middle, ring, and 5th digit: (0-90º)
Thumb ROM: IP (0-80º)
SA: Axis:
Thumb ROM: MP (0-50º)
SA: Axis:
Apprehension Test What does it test for?
Tests for: Anterior instability, instability of the GH, Labral, SLAP tears -Patient supine, standing or sitting. Shoulder placed 90° ABD, elbow 90° flexion, externally rotate the humerus - Positive test for anterior instability indicated with apprehension by patient or report of pain. - Relocation test performed after positive Apprehension test by applying posterior pressure on proximal humerus and noting patient sense of relief
Empty Can Test What does it test for?
Tests for: Impingement Test, Supraspinatus - Patient elevates arms to 90◦ in the scapular plane with thumbs pointed down (empty can position). - Examiner provides downward pressure on arm and notes patient strength. - Positive test is increased weakness in the empty can position (vs full can position), complaint of pain, or both.
Hawkins-Kennedy Test What does it test for?
Tests for: Impingement or Rotator Cuff tears - Stand in front of involved shoulder - Examiner raises patient's arm to approximately 90◦ of shoulder flexion and elbow flexion and applies forced humeral internal rotation. - Positive if shoulder pain is reproduced
Drop Sign Test What does it test for?
Tests for: Infraspinatus tears - Examiner stands behind patient.Grasps patient's elbow with one hand and wrist with other. - Places elbow in 90o flexion and 90o shoulder flexion in scapular plane - Passively externally rotates shoulder to near end range. - Patient asked to maintain this position as wrist is released. - Positive test for infraspinatus tear is indicated by a lag or "drop" that occurs with the inability of patient to maintain the arm in near full external rotation.
Sulcus Sign What does it test for?
Tests for: Labral Tears, GH laxity - Patient assumes a sitting position with examiner behind. -Examiner grasps humerus proximally to the elbow and pulls down causing an inferior traction force. The other hand is to stabilize and palpate the AC joint. - Examiner notes number of centimeters between inferior surface of acromion and superior portion of humeral head.
Painful Arc Test What does it test for?
Tests for: Subacromial Impingement -Patient stands and examiner faces to observe shoulder motion. -Patient instructed to actively abduct the involved shoulder -Positive test indicated when pain reported in 60-120 range. -Pain outside this range is a negative result.
Lift-Off Test What does it test for?
Tests for: Subscapularis tears - Patient is standing with affected arm behind his/her back. - Patient is asked to lift the arm off the back. Examiner resists motion. - A positive test for subscapularis tear is indicated by inability to lift the arm off the back.
Full Can Test What does it test for?
Tests for: Supraspinatus - Patient elevates the arm to 90◦ with thumbs up in the scapular plane (full can position). - Examiner provides downward pressure on the arms and notes the patient's strength. - Positive test for rotator cuff tear is increased weakness in the involved shoulder, complaint of pain, or both.
Drop Arm Test What does it test for?
Tests for: Supraspinatus Tears -Passively abduct pt.'s shoulder to over 90 degrees -Then ask patient to slowly lower the arm to the side -Positive: if patient is not able to hold the arm and drops when lowered to 90 degrees
Neer's Test What does it test for?
Tests for: impingement of the rotator cuff tendons under the coracoacromial arch) - Examiner stabilizes patient's scapula with one hand, passively elevate the affected arm in a scapular range of motion - Original test is with the shoulder in neutral rotation, other versions place the shoulder in internal rotation for the starting position. - Positive: patient reports pain in the anterior - lateral aspect of the shoulder
Circumferential Measurement: Elbow
in cm
Circumferential Measurement: Forearm [5 cm distal to the elbow crease with elbow @90 degrees]
in cm
Circumferential Measurement: MCP's
in cm
Circumferential Measurement: Wrist
in cm
Circumferential Measurement: Finger
in cm placement: