when we um evaluate um potential problem for the shoulder there are several uh factors that we need to uh consider before we kind of dig uh deeper to decide what kind of assessment tools that we want to use well first of all uh we want to observe our clients movement like when they walk into a clinic um are they using any compensation movement to avoid pain um uh what is their age uh what is their daily routine why these are important for example um the most common uh problem that we see for the shoulder is a rotator cuff injury so rotat cuff injury uh we see uh this problem uh are in uh more in uh um person with older uh age like after 50 um so if it's a young um adult who show symptoms of rot rotated cuff uh that can be something that we want to understand the mechanism of getting injured um it's not just know aging that cause this kind of uh problem and also uh if they're younger younger sorry if they're younger uh the healing process can be shortened right but also just because they're young they tend not to follow um the protocol that we offer them so these are the characters that we need to consider and also what is their da routine so how they use their um shoulder uh on a daily basis is it just that all a sudden uh they change their habit to do it or um they keep doing it using the same pattern that then that shows that this problem can be chronic right and a different approach that needs to be uh used to break that habit because we know it is so hard to uh ask a person to change the way that you know they do things right and when we are uh thinking about shoulder problem we want to do some kind of cervical screening uh to rule out the problem that's um that um come um comes from the neck okay and the type of pain really matters because um it can be the muscle weakness like the pain that kind of shows when when whenever we use the muscle or is it a nerve pain that kind of shows the nerve symptoms like numb or tingling or shooting or this kind of pain can tell us a lot of stories uh for the purpose of uh this lecture uh I'm not going to focus on everything but more uh to introduce you some kind of provocative test that we use in the clinic that uh that help us to confirm um what kind of problem um our uh client may have or uh we can use this to refer them back to the physician to asking uh them to do more uh accurate testing by saying provocative tests I meant a lot of time we um we do the evaluation to provoke the symptom right for shoulder uh test that I'm going to introduce you today is to uh to that we will provoke pain uh um that certain MUSC if certain muscle are injured or is injured and what kind of uh symptoms that that they may show um the first um test is called arcco pain or pain for Arc of motion um um this can uh we can ask uh our client to flex the arm or Abu uh abduct the arm and you can see uh uh per the norm uh um in the beginning and uh at the beginning phase and end phase uh they don't um experience the pain it is at the middle uh range typically is between 60° and 120 degrees of abduction or shoulder flexion that uh our client uh may experience pain and U here's a link and feel free to uh click the link and that would lead you to the otu video and actually see how um we uh evaluate um the shoulder problem using the arop pan here but uh when our client demonstrate U painful range between 60 and 120 uh degrees of uh AB flu uh sorry a deduction or show def flection that typically not exact but typically is related to uh the rot cuff or uh the Bersa that's underneath the coral a chromian arch that's right there okay so now since we are doing a provocative test we are applying resistance to uh the movement it is different from uh what you do for the men muscle test because Min muscle test it has a specific standardized position but uh the uh resistant movement uh the strength sorry the strength testing that I'm showing you here is you know we are trying to induce the pain right so by providing resistance so um the position May uh look different uh to what you learn uh from the mainten muscle test um um and r r motion evaluation that that we cover in a shoulder so in General when we uh provide resistive U um test to a specific position we're asking uh the our client to do isometric uh contraction when uh the pen is induced then we can um we can uh um conclude that they may have some kind of problem for a certain certain uh muscle group okay um here's our uh um a different grade that we use um if if the muscle uh you feel strong and then they don't uh report any pain then it is normal when sorry when it is strong but you know they uh our client report some pain that may shows uh some kind of ATT tendonitis kind of going on right or um it's just like starting um phase that they starting to feel something's wrong I apologize because I was not able to uh change this to three four and five but but it's a a Contin continuation from the previous slide if um um the the movement uh you the muscle you feel is uh weak and it's painful then it very much suggests that uh the condition is in in moderate to high uh irritation so that will be something that you know we definitely want to refer uh to the visitant to make sure if it was not documented um if it's weak and they don't feel pain typically it just move into uh a massive uh uh stage or uh move into a chronic stage that may uh we need to uh be really careful because uh they may this may involve some kind of nerve injury if it's all painful whatever they move or whenever they move that means uh this is at a very acute stage that U information is U is dominating the whole thing typically we don't want to touch it right so we want to make sure that they uh we don't irritate the the symptoms okay so these are um similar uh these are uh the grading U so uh the test the first the first test uh that want that I want to introduce you is a speeds test uh speed test is specifically uh used to uh evaluate the biceps so what we do as you can see the picture here and feel free to click on the link we can see the picture here that we put uh our client in um uh mid uh shoulder flexion pump up and then we apply resistance to the form form here and then we put the other hand on the the biceps when we apply resistance and um we provoke some pain and that would demonstrate that our patient have some kind of bicep problem and uh another test is rotator cuff manual resistive test uh if you recall uh there are four muscles for rotator cuff their function is not just to do rotation right there are several muscles that are doing different things so uh if we provide uh resistive um uh strength to external rotation we are testing the internal rotators uh which are infraspinatus and terrist minor U so we apply resistance and then they report pain then we can um um say that they may have some kind of problem for infraspinatus and teras Miner and since thing appli to a resisted internal rotation for subscapularis and pec minor and we can put the uh the the um shoulder in adduction and elbow in flexion right and do external and the internal rotation we can move the elbow away from the body for about 15 degrees and then we apply resistance that way uh our coin are is doing uh resistive uh abop ction if they report pain that which shows there's some kind of problem for the super spitus um there are several other things that uh we can do for the Rotator cff for example uh for the drop arm test we uh position the arm in AB duction and then uh internal rotation um sorry this is this should be 90 Dees not 900 but 90 90° here um and then we ask the client to hold in this position and if they can hold it that's fine and then uh after they hold it we can ask them to slowly lower the arm um if they fail to hold or if they fail to slowly load the arm that would be a good uh indicator for um um problem at the Su spanis and for the external uh rotation s we uh can also use external Rotator rotation leg sign um here we put um uh we bend the elbow in 90 degrees and shoulder in 20 degrees of ab duction and then we move the arm to external rotation here and then we ask the client to hold in this position and if they um uh have problem with infraspinatus and terce minor um they may move uh the arm into to um internal rotation and that would be a good indicator to tell us that our client may have some kind of problem with infr spinatus and U ter Miner and then uh in uh internal rotate rotation sign test is for used for subcap erors again we place the arm behind the back and then leave the arm off the the back and then we asked them to hold in this position and fail to do so that would be uh indicative for a problem um at subcis