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In both tests, the patient is placed in a standing or sitting position, and the arms are raised parallel to the ground in the scapular plane. [2] The tests differ in the rotation of the arm; in the empty can test, the arm is rotated to full internal rotation (thumb down) and in the full can test, the arm is rotated to 45° external rotation, thumb up. [1]
The light bulb sign is best observed on an AP radiograph of the shoulder. [5] Key features include: Rounded humeral head: The humeral head appears symmetrically rounded, resembling a light bulb due to internal rotation. Loss of normal glenohumeral overlap: The humeral head is posteriorly displaced, disrupting the alignment with the glenoid cavity.
Evaluation of passive and active range of motion: Neck range of motion should be assessed that may reveal a neck source of shoulder pain. The Apley scratch test specifically tests range of motion and in a normal exam, an individual should be able to reach C7 on external rotation, and T7 on internal rotation. Evaluation of distal pulses
When performing the Neer impingement test, the elbow should be extended, humerus in internal rotation and the forearm pronated. When the examiner is passively flexing the arm forward, it is causing compression of the structures between the greater tuberosity, inferior acromion process and the acromioclavicular joint. [1]
Arthrography of shoulder joint (with or without computed tomography) is performed by injecting contrast below and lateral to the coracoid process to outline the shoulder joint. Axillary pouch of the shoulder can be seen on external rotation, while subscapular (subcoracoid) bursa can be seen on internal rotation of arm.
Shoulder motions to pull the ligament taut Humeral head motion to pull the ligament taut Superior glenohumeral lig. Full adduction Inferior or anterior glide Middle glenohumeral lig. External rotation Anterior glide Inferior glenohumeral lig. Anterior band Posterior band Abduction and external rotation Abduction and internal rotation Non specific
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The muscles of internal rotation include: of arm/humerus at shoulder. Anterior part of the deltoid muscle [1] Subscapularis [1] Teres major [1] Latissimus dorsi [1] Pectoralis major [1] of thigh/femur at hip [2] Tensor fasciae latae; Gluteus generalis; Anterior fibers of Gluteus meralis; Adductor longus and Adductor brevis; of leg at knee [3 ...
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