Name of test
Shoulder elevation / forward flexion
What it tests
The patient's ability to forward elevate. This is similar to abduction, but in the sagittal plane.
How to do it
- stand in front of the patient
- Ask the patient to lift the arm in the sagittal plane as high as possible, ie to "touch the ceiling."
- Assess the arc of motion but also if the patient can do it directly (as opposed to abducting and then adducting, ie elevating in the coronal plane preferentially).
The normal response
About 180 degrees.
Compare to the contralateral side.
What it means if not normal
Assess the difference between "can't do it" and "won't do it". If the patient simply won't do it, that's often from pain and rotator cuff tendinosis. If they can't do it, then passive motion has to be checked. Normal passive motion in the setting of abnormal active motion suggests rotator cuff failure or possibly a neurological injury.
Comments
Citations
Bernstein J, 2004 Mar-Apr. "Evidence-based medicine." J Am Acad Orthop Surg 12 (2): 80-8 [PubMed]
Abstract:
Evidence-based medicine refers to an explicit process of using and evaluating information to make medical decisions. Evidence-based medicine, perhaps contrary to popular perception, requires its users to embrace uncertainty in medical decision making because information that is simultaneously true and complete cannot be attained. Recognizing medicine's inherent uncertainty, proponents of evidence-based medicine advocate using a five-step process for sound decision making: formulate answerable questions, gather evidence, appraise the evidence, implement the valid evidence, and evaluate the process. The formulation of answerable questions requires categorizing the facts of the case in terms that allow comparison to evidence gathered from prior studies. The appraisal of the evidence uses the tools of clinical epidemiology to assess the validity and applicability of the evidence. Implementation refers to the construction of a clinical plan based on the evidence collected as well as on the physician's judgment and patient's preferences. Finally, evidence-based medicine requires continued evaluation and refinement. The methods of evidence-based medicine are especially germane to contemporary medicine as physicians practice under increasing demands to deliver optimal outcomes yet face an ever-expanding body of medical knowledge.
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