By Paul Hattam MSc MCSP FSOM, Alison Smeatham MSc MCSP FSOM
The proliferation of particular exams utilized in musculoskeletal exam has left the clinician with an unlimited array of actual assessments at their disposal. Special assessments in Musculoskeletal exam is a convenient one-stop consultant with over one hundred fifty peripheral checks. The scientific context and proof base is carefully explored and the addition of medical information and professional opinion will allow the clinician to choose the main applicable checks and interpret the implications meaningfully.Step-by-step description for every test Clear photographic illustrations'At a look' presentation of the heritage evidenceDetailed scientific contextComprehensive referencing of orthopaedic targeted testsClinical assistance
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Extra resources for Special Tests in Musculoskeletal Examination: An evidence-based guide for clinicians (Physiotherapy Pocketbooks)
There is a strong correlation between labral tears and other symptoms at the shoulder (Liu et al 1996). In an arthroscopic study of 100 shoulders, 68% of patients with impingement symptoms were found to have superior labral tears whereas 92% of patients with recurrent anterior instability had antero-inferior tears identified (Hurley & Anderson 1990). Patients with functional instability report catching and locking of the shoulder during movement and feel unable to ‘trust’ their shoulder, particularly when loading the arm in elevated positions.
This position causes the articular aspect of the rotator cuff tendons to become pinched between the humeral head and the posterosuperior part of the glenoid labrum. The internal rotation resistance strength test (see p. 42) can help in making a distinction between internal and primary impingement. Clinical tip Internal impingement can occur in conjunction with shoulder instability, the test position being very similar to the apprehension test (see p. 56) (Jobe et al 1989), so a positive test should be interpreted in the light of the patient’s history and other examination findings.
Clinical tip The functional nature of this test (turning a steering wheel) makes it an easy one for the clinician to remember!