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Anatomy

Upper Limb

Question 74 of 239

Your consultant performs a thorough shoulder examination on a patient with suspected rotator cuff injury on his left side. He asks the patient to position his left arm in full medial rotation with the dorsum of his hand on the lower back. He then asks the patient to lift his hand away from his back against resistance. Which of the following muscles is being assessed:

 

Answer:

This is the lift-off test used to assess the subscapularis muscle. The test is positive if the patient has pain or weakness.

Rotator Cuff Muscles

Anatomy / Upper Limb / Shoulder

Last Updated: 20th February 2019

The rotator cuff is a common name for the group of four distinct muscles and their tendons that provide strength and stability during motion of the shoulder. They are also referred to as the SITS muscle with reference to the first letter of their names:

  • Supraspinatus
  • Infraspinatus
  • Teres minor
  • Subscapularis

Table: Function and Assessment of the Rotator Cuff Muscles

Muscle (Innervation) Function Assessment
Supraspinatus (suprascapular nerve) Initiation of abduction of arm to 15 degrees at glenohumeral joint Empty Can Test: Position the patient with arms elevated to 90 degrees in the scapular plane, with the elbow extended, and full medial rotation and pronation of the forearm with thumbs pointing downwards. Ask the patient to resist the downward force being applied to the forearm.  Test is positive if patient has pain or weakness.
Infraspinatus (suprascapular nerve) Lateral rotation of arm at glenohumeral joint Infraspinatus Test: Position the patient with the arm fully adducted, with the elbow flexed to 90 degrees. Ask the patient to resist the medially directed force being applied to the arm. Test is positive if patient has pain or weakness.
Teres minor (axillary nerve) Lateral rotation of arm at glenohumeral joint Hornblower’s Test: Position the patient with the arm elevated to 90 degrees in the scapular plane and the elbow flexed to 90 degrees. Ask the patient to laterally rotate the arm against resistance. Test is positive if patient has pain or weakness.
Subscapularis (subscapular nerves) Medial rotation of arm at glenohumeral joint Lift-off Test: Position the patient in full medial rotation with the dorsum of the hand on the lower back. Ask the patient to lift their hand away from their back against resistance. Test is positive if patient has pain or weakness.

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Rotator Cuff Muscles. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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