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Zorluk: OrtaPhysical Examination Findings

A 45-year-old male construction worker presents to the primary care clinic complaining of right shoulder pain that has progressively worsened over the past three months. He denies any acute trauma but notes deep pain with overhead activities and a sense of weakness when lifting heavy materials at work. As part of his clinical evaluation, the physician performs various provocative maneuvers of the shoulder. Match the following physical examination maneuvers with the corresponding anatomical structure or pathology they are designed to evaluate.

  • Jobe (empty can) testAssessment of supraspinatus muscle strength and integrity
  • Lift-off testAssessment of subscapularis muscle strength and integrity
  • O'Brien active compression testEvaluation for a superior labrum anterior-posterior (SLAP) tear
  • Hawkins-Kennedy testEvaluation for subacromial impingement syndrome

Cevap

Jobe test matches to supraspinatus evaluation; Lift-off test matches to subscapularis evaluation; O'Brien test matches to SLAP tear evaluation; Hawkins-Kennedy test matches to subacromial impingement evaluation.
Establishing an accurate clinical diagnosis for shoulder pain relies heavily on distinct physical examination maneuvers. Each maneuver biomechanically isolates a specific tendon, muscle, or joint structure. The correct pairings represent the gold-standard clinical correlations utilized in musculoskeletal medicine: Jobe for supraspinatus, Lift-off for subscapularis, O'Brien for superior labral (SLAP) lesions, and Hawkins-Kennedy for subacromial impingement.

Adım Adım Çözüm

1
Analyze the mechanical forces applied during the Jobe (empty can) test.
The positioning isolates the supraspinatus muscle by minimizing the contribution of the deltoid.
Internal rotation and forward flexion in the scapular plane specifically target the superior aspect of the rotator cuff (supraspinatus).
2
Analyze the mechanical forces applied during the Lift-off test.
The positioning requires active internal rotation of the shoulder from a mechanically disadvantaged position behind the back.
The subscapularis is the primary internal rotator of the shoulder; this test isolates its function from the pectoralis major and latissimus dorsi.
3
Analyze the mechanics of the O'Brien active compression test.
Internal rotation with forward flexion loads the bicipital-labral complex.
Pain that occurs deep in the shoulder with the thumb pointing down (internal rotation) and is relieved with the thumb pointing up (external rotation) specifically implicates the superior labrum.
4
Analyze the mechanics of the Hawkins-Kennedy test.
Passive internal rotation with the arm at 90 degrees of forward flexion drives the greater tuberosity under the coracoacromial arch.
This physical impingement of the bursa and rotator cuff tendons against the arch confirms subacromial impingement syndrome.

Anahtar Kavram

Shoulder physical examination maneuvers must be accurately correlated with the specific anatomical structures they isolate or provoke to guide diagnosis and treatment of shoulder pathology.
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Physical Examination Findings

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