00:00:0400:00:06
This is Brent of the Brookbush Institute, and
00:00:0600:00:08
in this video we're doing the jerk test.
00:00:0800:00:10
A special or orthopedic test for the
00:00:1000:00:13
shoulder, that helps us indicate a
00:00:1300:00:16
posterior inferior labral lesion. I'm
00:00:1600:00:17
going to have my friend Melissa come out,
00:00:1700:00:19
she's going to help me demonstrate. Now
00:00:1900:00:22
this is kind of tricky, we have to
00:00:2200:00:25
combine some actions that are not so
00:00:2500:00:27
easy to combine; which is stabilization
00:00:2700:00:30
of the scapula, we have to compress the
00:00:3000:00:32
humeral head into the glenoid fossa, and
00:00:3200:00:34
then we're going to simultaneously
00:00:3400:00:38
horizontally adduct the humerus. So
00:00:3800:00:41
here's what that looks like. We're going
00:00:4100:00:43
to take this hand the hand closest to
00:00:4300:00:44
the patient and we're going to put it
00:00:4400:00:46
right over the top of the scapula, and
00:00:4600:00:47
then our palm down over the back of the
00:00:4700:00:49
scapula. We're going to take our other
00:00:4900:00:51
hand using our lumbrical grip, that
00:00:5100:00:53
little crab or lobster grip, we're going
00:00:5300:00:56
to put that right over the elbow. Now
00:00:5600:00:58
we're going to start at 90 degrees of
00:00:5800:01:00
abduction, and roughly 90 degrees of
00:01:0000:01:02
shoulder internal rotation here, and I'm
00:01:0200:01:06
now going to press her humerus into her
00:01:0600:01:09
glenoid fossa. So my force will always be
00:01:0900:01:12
directed in line with the humerus itself,
00:01:1200:01:17
an axial load so to speak, and so we're
00:01:1700:01:19
going to push in this way, and then
00:01:1900:01:21
here's where it gets tricky. Maintaining
00:01:2100:01:24
that load I'm going to horizontally adduct
00:01:2400:01:28
the humerus, while asking my
00:01:2800:01:30
patient does that replicate your
00:01:3000:01:32
symptoms? Yeah. that's what you were
00:01:3200:01:36
complaining about. Where do you feel that? In
00:01:3600:01:39
the back of her shoulder. Alright so a
00:01:3900:01:44
positive Jerk test is the onset of pain
00:01:4400:01:47
in the back of the shoulder, with or
00:01:4700:01:49
without clicking. Of course clicking you
00:01:4900:01:51
can either hear or feel as you're going
00:01:5100:01:53
through the test. The most important
00:01:5300:01:54
thing is it does it replicate your
00:01:5400:01:57
patient symptoms. I'll show you guys a couple of
00:01:5700:01:59
other views here. Let me have you move
00:01:5900:02:01
this way Melissa. I just want you guys to clearly see
00:02:0100:02:04
the mechanics of this. Notice hand, top
00:02:0400:02:06
and then bracing the back of your
00:02:0600:02:08
scapula. I also have good control over
00:02:0800:02:11
her torso here. I'm then going to use
00:02:1100:02:12
this grip
00:02:1200:02:15
over her elbow, and then notice i get my
00:02:1500:02:19
elbows up nice and high so that my forearms
00:02:1900:02:22
match my directions of force pretty good.
00:02:2200:02:24
This is going to make it a lot easier on
00:02:2400:02:26
me, and then all i have to do is take a
00:02:2600:02:30
step and I can take her into a
00:02:3000:02:32
horizontal adduction, while maintaining
00:02:3200:02:35
that force in line with the humerus,
00:02:3500:02:37
compressing the humeral head, and I'm
00:02:3700:02:39
going to ask her is that the symptoms
00:02:3900:02:41
you were talking about? Where do you feel
00:02:4100:02:45
that? In the back of your shoulder, all
00:02:4500:02:46
right positive Jerk test. Alright go
00:02:4600:02:49
ahead and flip all the way around .One
00:02:4900:02:54
last view of my mechanics here. So this
00:02:5400:02:58
hand over the top stabilizing the back
00:02:5800:03:01
of the scapula. This hand over the top of
00:03:0100:03:04
her elbow, bracing her humerus, I've got
00:03:0400:03:06
good control here, I'm going to get my
00:03:0600:03:08
elbows up nice and high. I'm just going
00:03:0800:03:11
to take a step as I continued to
00:03:1100:03:16
compress her humeral head into her
00:03:1600:03:18
glenoid fossa, and of course all the
00:03:1800:03:22
while I'm asking does that match the
00:03:2200:03:24
symptoms you were talking about, is that
00:03:2400:03:25
what you were complaining about, where
00:03:2500:03:29
did you feel that. Alright, thank you Melissa.
00:03:2900:03:33
Now if I'm doing the Jerk test that's
00:03:3300:03:37
just one clue towards an assessment or
00:03:3700:03:40
diagnosis of what may be contributing to
00:03:4000:03:44
my patients complaints, I'm going to do
00:03:4400:03:46
other tests to confirm this assessment
00:03:4600:03:49
or diagnosism chances are if I've done
00:03:4900:03:51
the Jerk test I'm also going to do the
00:03:5100:03:52
Kim's test, because that's my other
00:03:5200:03:55
posterior inferior labral lesion test.
00:03:5500:03:59
Chances are I've already done my SLAP
00:03:5900:04:02
lesion tests. Things like the O'Briens
00:04:0200:04:04
active compression test and and maybe
00:04:0400:04:07
even Speeds, but I want to make sure that
00:04:0700:04:09
as I'm putting this together, I'm putting
00:04:0900:04:11
all my clues together, I have some
00:04:1100:04:14
negatives to ensure that it's not that
00:04:1400:04:16
diagnosis, it's not like a SLAP tear.
00:04:1600:04:20
Maybe I've done my impingement tests, my
00:04:2000:04:23
rotator cuff tests, and I know if those
00:04:2300:04:26
are negative but these are positive I'm
00:04:2600:04:28
really really on the right track. Now
00:04:2800:04:30
chances are you're going to get a mixed
00:04:3000:04:32
bag, and you're also going to have to
00:04:3200:04:35
match it up with a subjective evaluation. Now
00:04:3500:04:37
why is this all important, with our
00:04:3700:04:39
diagnostic testing you have to keep in
00:04:3900:04:42
mind is this patient going to get better
00:04:4200:04:44
with conservative treatment, i.e manual
00:04:4400:04:47
therapy and exercise. Or should I refer
00:04:4700:04:49
out to a physician, because there's a
00:04:4900:04:52
chance that we need some imaging maybe
00:04:5200:04:54
to make a better decision. Or is there a
00:04:5400:04:57
chance that surgical intervention is
00:04:5700:05:00
actually going to be the better solution
00:05:0000:05:04
for this patient right. You don't
00:05:0400:05:05
necessarily have to make that decision,
00:05:0500:05:09
if you are leaning towards a significant
00:05:0900:05:12
labral lesion that could need surgical
00:05:1200:05:15
intervention, personally I would go ahead
00:05:1500:05:18
and refer up to a physician, try to get
00:05:1800:05:19
some imaging, maybe talk with that
00:05:1900:05:22
physician and may be jointly we decide
00:05:2200:05:24
whether we should try conservative
00:05:2400:05:27
treatment at all, or we should skip
00:05:2700:05:30
straight to surgical intervention. I hope
00:05:3000:05:32
you guys enjoyed this video, give this
00:05:3200:05:34
test a try, it's a little tricky. I would
00:05:3400:05:36
practice it before using it in the
00:05:3600:05:38
clinic. If you have any questions leave a
00:05:3800:05:40
comment below.