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Advanced Musculoskeletal Assessment
Chapter 4: Shoulder Impingement
45 mins left
Differentiate primary vs secondary shoulder impingement. Highlights Neer's and Hawkins-Kennedy tests.
0:00 / 2:30
Interactive Transcript (Seek on click)
- 0:00 Welcome. Today we're assessing subacromial impingement.
- 0:30 We start with the Hawkins-Kennedy test. Elevate arm to 90°.
- 1:15 Slowly internally rotate. A positive test is pain reproduction.
- 1:50 Painful Arc Sign. Patient active abducts, pain between 60°-120°.
- 2:15 Combine tests into cluster for optimal specificity (>90%).
Which test is most sensitive for impingement?
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❤️ Vitals — mobilize / hold
acute
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SBP
90-180
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TTWBToe-touch — affected foot rests for balance only (~10% BW)
PWBPartial — typically 25-50% BW, per surgeon
WBATWeight bearing as tolerated — patient controls progression
FWBFull — no restriction
🫀 Sternal precautions
post-CABG
NOLifting > 10 lbs · UE press-ups
NODriving × 4-6 wks · arms behind back
OKFunctional arm use within shoulder ROM
OKCough/sneeze with sternal splint pillow
FACTSFunctional Active Cardiac Therapy Sternal — arms used within pain limits
🦴 Hip precautions
post-THA
POSTERIORNO flexion > 90°, NO adduction, NO internal rotation
POSTERIORNO crossing legs · pillow between knees · elevated toilet
ANTERIORNO extreme extension, NO external rotation, NO crossing legs
ANTERIOROK to flex past 90° unlike posterior · no bridging early
TIMEMost precautions 6-12 wks unless cemented
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HGB<8 hold AROM·resistance; <7 bedrest/transfusion typical
PLT<20K NWB only; 20-50K low-resistance only; >50K OK
WBC<1000 reverse isolation; consult MD
INR>4 hold resistance; >5 hold therapy (bleed risk)
BG<70 treat first · >400 hold exercise · >250 + ketones hold
Cr/BUNRising Cr + BUN/Cr >20 = dehydration; hold high-intensity
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red flag
FFACE drooping — uneven smile, can't close one eye
AARM drift — one arm drops when both held out 10s
SSPEECH slurred — repeat phrase, listen for slurring
TTIME — call 911 + note onset time (tPA window 4.5h)
ALSOSudden severe HA · vision loss · gait ataxia · LOC change
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