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Anatomy and physical exam of the shoulder
- 1. ANATOMY AND PHYSICALEXAM OF THE SHOULDER -- GONZALO SAMITIER MD PHD ORTHOPAEDIC SURGEON - EUROPEAN BOARD CERTIFIED FELLOW ORTHOPAEDIC SPORTS MEDICINE DIVISION HENRY FORD HEALTH SYSTEM (DETROIT, MI) WWW.HENRYFORD.COM
- 2. OBJETIVES • Review pertinentAnatomy • Review Physical Exam
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- 18. Clinical aplications: - Bicepstendon - Rotator Cuff - Post surgical rotator cuff - Guiding injections Basics: - Expose shoulder - Position patient - Darken Exam room - Estabilize transducer - Bilateral comparison - Bone cortex bright white hyperechoic - Fluid black or very dark hypoechic or anechoic - Calcium deposits black or very dark hypoechic - Rotator cuff tears black or very dark hypoechic ANATOMY ON US
- 19. The 13 pointShoulder Ultrasound exam. Don Buford (Dallas – Texas)
- 34. Summary • Get oriented •Get trained • Get a routine • Practice Disvantages • Can not see throught gas or bone • Relatively limited to deep penetration • Operator dependent imaging modality • Hardware dependent imaging modality ANATOMY ON US
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- 36. Dr. Oscar Fariñas;Dr. Iván Sáenz. Facultad de Medicina de la Universidad de Barcelona.
- 37. DELTOPECTORAL APPROACH Watch the Videoat: https://www.youtube.com/channel/UCqppa1V7WkCjwjOFDClNFkg
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- 40. PHYSICAL EXAM –INSPECTION • Front & Back • Height of shoulder & scapulae • Asymmetry • Obvious deformity • Ecchymosis • Muscle atrophy
- 41. PALPATION • At rest& with movement • Bony structures • Joints • Soft tissues
- 42. PALPATION Surface Anatomy (Anterior) •Clavicle • SC Joint • Acromion process • AC Joint • Deltoid • Coracoid process • Pectoralis major • Trapezius • Biceps (long head) AC joint SC joint biceps
- 43. PALPATION Surface Anatomy (Posterior) •Scapular spine • Acromion process • Supraspinatus • Infraspinatus • Deltoid • Trapezius • Latissumus dorsi • Scapula Supraspinatus Infraspinatus Inferior angle of scapula
- 44. RANGE OF MOTION •Forward flexion: 160 – 180° • Extension: 40 – 60° • Abduction: 180◦ • Adduction: 45 ° • Internal rotation: 60 - 90 ° • External rotation: 80 - 90 °
- 45. STRENGTH TESTING • Gradestrength on 0 → 5 scale • 0: no contraction • 1: muscle flicker; no movement • 2: motion, but not against gravity • 3: motion against gravity, but not resistance • 4: motion against resistance • 5: normal strength
- 46. SPECIFIC PROVOCATIVE TESTS •Impingement Signs • Rotator cuff tears • Biceps tendon pathology • AC joint • Instability
- 47. SUBACROMIAL IMPINGEMENT SYNDROME Impingement of: •Subacromial bursa • Rotator cuff muscles and tendons • Biceps tendon Between • Acromion • Coracoacromial ligament • AC joint • Coracoid process • Humeral head
- 48. IMPINGEMENT SIGNS Neer’s SignHawkins sign
- 49. ROTATOR CUFF TEARS •Drop arm test • Jobe test • Isolation test SS • Horn blower test • External rotation lag sign • Lift off test • Napoleon • Belly press test
- 50. BICEPS TENDON • Speedtest • Yergason maneuver • O’Brien test • Popeye sign
- 51. AC JOINT • Crossarm test • Abd-Add test
- 52. SHOULDER INSTABILITY • Aprehensiontest • Relocation test • Anterior drawer • Load and shift test • Sulcus test • Jerk test • Posterior drawer
- 53. GLENOID LABRAL TEAR •Obrien’s test • Crank test
- 54. DIAGNOSTIC INJECTION • ACjoint • Subacromial space • Glenohumeral joint • Biceps tendon (long head)
- 55. ROTATOR CUFF TEAR History/ Maneuver Study Qual Sens (%) Spec (%) LR+ LR- PV+ (%) PV- (%) History of trauma 2b 36 73 1.3 0.88 72 37 Night pain 2b 88 20 1.1 0.6 70 43 Painful arc 2b 33 81 1.7 0.83 81 33 Empty can test 1b 84 89 50 58 1.7 2 0.22 0.28 36 98 22 93 Drop arm 1b 21 100 >25 0.79 100 32
- 56. IMPINGEMENT / INSTABILITY Test Study Qual Sens (%) Spec (%) LR+LR- PV+ (%) PV- (%) Impingement Hawkin’s 1b 87 89 60 2.2 0.18 71 83 Instability Relocation 2b 57 100 >25 0.43 100 73 Apprehension 2b 68 100 >25 0.32 100 78
- 57. AC JOINT /SLAP TEAR History / Maneuver Study Qual Sens (%) Spec (%) LR+ LR- PV+ (%) PV- (%) AC Joint Active compression 1b 100 97 >25 0.01 89 100 SLAP Tear Crank 2b 91 93 13 0.10 94 90 Active compression 1b 100 99 >25 0.01 95 100
- 58. DIFFERENTIAL DIAGNOSIS Diagnosis PrimaryCare % Age Subacromial Impingement Syndrome 48-72 23-62 Adhesive Capsulitis 16-22 53 Acute Bursitis 17 - Calcific Tendonitis 6 - Myofascial Pain Syndrome 5 - Glenohumeral Joint Arthrosis 2.5 64 Thoracic Outlet Syndrome 2 - Biceps Tendonitis 0.8 -
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