Anatomy and physical exam of the shoulder
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This document provides information on the anatomy and physical exam of the shoulder. It begins with objectives to review pertinent anatomy and the physical exam. It then details various anatomical views of the shoulder that can be seen on x-ray, MRI, and ultrasound. The document outlines the steps for physically examining the shoulder, including inspection, palpation, range of motion testing, and specific provocative tests for conditions like impingement, rotator cuff tears, and instability. It concludes with providing sensitivity and specificity data for some physical exam maneuvers and differential diagnoses for shoulder pain.
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Scan Exam
The scanning examination is used in physical therapy to:
1) Ensure a patient's presentation is appropriate for physical therapy by ruling out serious pathology like fractures or neurological issues.
2) Detect gross loss of function, range of motion deficits, and movement deviations.
3) Help identify common orthopedic conditions like disc herniations, arthritis, or tendonitis.
The scanning exam involves observation of gait, posture, and movement quality as well as tests of vital signs, functional movement, tissue tension, palpation, neurological function, and special orthopedic tests for different body regions.
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This document discusses the examination of the hip joint. It outlines the traditional steps in examining the hip, including taking a history, inspecting for deformities, palpating for tenderness, and measuring range of motion. Special tests are also described, such as the Trendelenberg test to assess abduction weakness. A variety of hip conditions can be evaluated through clinical examination, including developmental dysplasia of the hip, Perthes disease, tuberculosis, and traumatic injuries. Proper examination of gait, identification of fixed deformities, and use of special tests remains an important orthopedic skill.
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Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'Kin191 A.Ch.6.Knee.Patellofemoral.Evaluation
This document provides an overview of evaluation techniques for lower extremity injuries, focusing on the knee and patellofemoral articulation. It describes evaluating the history, inspecting for signs of injury, palpating anatomical structures, performing range of motion and stress tests, and assessing neurologic and vascular function. The evaluation techniques are organized by anatomical area and include tests for ligaments, meniscus, and patella to isolate potential injuries.
Ortho con
1) A 14-year-old boy was in a motorcycle accident where his left hip hit the ground, causing left hip pain and deformity.
2) Examination and x-rays revealed a posterior dislocation of the left hip.
3) The patient was taken to the operating room for closed reduction of the hip dislocation under general anesthesia with skeletal traction.
Examination of shoulder
This document provides an overview of an examination of the shoulder, including:
1) Anatomy of the shoulder bones, joints, and muscles like the rotator cuff.
2) Traditional steps for examining the shoulder including taking a history, inspecting, palpating, assessing range of motion, and performing special tests.
3) Details on examining range of motion, palpating for tenderness, and performing special tests to identify issues like impingement, rotator cuff tears, and instability.
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This document discusses SLAP lesions of the shoulder. It defines SLAP lesions as injuries to the superior labrum. The etiology of SLAP lesions is controversial but may involve traction from the biceps tendon during throwing motions. People at risk include those with poor scapular control or tight posterior capsules. Physical exams do not conclusively diagnose SLAP lesions. Treatment involves a 3-phase rehabilitation program focusing on the kinetic chain, mobility, and strengthening. Core stability, scapular stabilization, and manual therapy techniques are emphasized. While surgery is an option, adaptive changes in throwers mean repairing anatomy may hinder performance. An integrated approach addressing the whole body is most effective for shoulder pain.
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Pelvic trauma
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Hamelynck Kj. Stability Of The Knee, A Dynamic Concept
This document discusses the stability of the normal knee and how it is affected by total knee replacement. The normal knee has intrinsic stability from its geometry and menisci, as well as extrinsic stability from ligaments, capsules, and muscles. It demonstrates rotations and translations during motion. Total knee replacement removes articular surfaces and cruciate ligaments, destabilizing the knee. Without properly functioning ligaments after surgery, the knee loses proprioceptive feedback and the range of passive motion increases, disturbing dynamic stabilization. To create good stability, the collateral ligament frame must be maintained without additional releases.
Posterior Instability
This document provides information on posterior instability of the shoulder. It discusses the mechanism of injury, incidence, diagnosis through x-rays, keys to success including portal placement and fixation options. Positioning for repair in beach chair position is described along with portals for posterior stabilization and techniques for suture passing and fixation using suture anchors, suture lassos, and knots. Additional stabilization techniques and potential complications are briefly touched upon.
Acetabular Fractures
Acetabular fractures are serious orthopedic injuries that occur when the femoral head is driven through the acetabulum, sometimes resulting in hip dislocation. They require rapid treatment and often surgery due to difficult access and proximity to blood vessels and nerves. Patients typically experience intense pain, swelling, deformity, and limited range of motion. While traction and immobilization are initial treatments, most patients need open reduction and internal fixation surgery to precisely realign the bones and prevent long-term issues. Major post-operative concerns include blood clots, infections, and avascular necrosis of the femoral head. Extensive physical therapy focuses on range of motion, strength, and mobility exercises to aid recovery.
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Clinical Examination of the Shoulder.pptx
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- The patient is a 53-year-old Thai man who fell 3 meters from his home after drinking alcohol, landing on his right hip. He has pain and inability to move his right leg. X-rays show an anterior dislocation of the right hip.
- In the emergency room, doctors were unable to perform a closed reduction of the dislocation. The patient was taken to the operating room for a closed reduction under general anesthesia with skeletal traction.
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The document provides an overview of common shoulder problems and how to perform a physical examination of the shoulder. It discusses evaluating the shoulder for issues such as impingement syndrome, rotator cuff tendinitis and tears, biceps tendinitis, adhesive capsulitis, glenohumeral osteoarthritis, and acromioclavicular injuries. The physical exam involves inspection, palpation, range of motion testing, strength testing, and special tests to reproduce symptoms and assess for injuries or limited function. Imaging such as x-rays or MRI may be used if further evaluation of injuries or chronic issues is needed.
Scan Exam
The scanning examination is used in physical therapy to:
1) Ensure a patient's presentation is appropriate for physical therapy by ruling out serious pathology like fractures or neurological issues.
2) Detect gross loss of function, range of motion deficits, and movement deviations.
3) Help identify common orthopedic conditions like disc herniations, arthritis, or tendonitis.
The scanning exam involves observation of gait, posture, and movement quality as well as tests of vital signs, functional movement, tissue tension, palpation, neurological function, and special orthopedic tests for different body regions.
Examination of the hip
This document discusses the examination of the hip joint. It outlines the traditional steps in examining the hip, including taking a history, inspecting for deformities, palpating for tenderness, and measuring range of motion. Special tests are also described, such as the Trendelenberg test to assess abduction weakness. A variety of hip conditions can be evaluated through clinical examination, including developmental dysplasia of the hip, Perthes disease, tuberculosis, and traumatic injuries. Proper examination of gait, identification of fixed deformities, and use of special tests remains an important orthopedic skill.
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This document provides an overview of performing an examination of the shoulder, including assessing functional anatomy, subjective factors, and objective tests. It describes the resting and closed pack positions of the glenohumeral, acromioclavicular, and sternoclavicular joints. Subjective factors covered include symptoms, aggravating/relieving factors, and past history. The objective examination involves observation, palpation, range of motion testing, strength testing, and multiple special tests to assess various structures like the labrum, biceps, rotator cuff, nerves. The goal is a thorough subjective and physical assessment of the shoulder.
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https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
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https://youtu.be/EXpgy19Jxzw
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https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'Kin191 A.Ch.6.Knee.Patellofemoral.Evaluation
This document provides an overview of evaluation techniques for lower extremity injuries, focusing on the knee and patellofemoral articulation. It describes evaluating the history, inspecting for signs of injury, palpating anatomical structures, performing range of motion and stress tests, and assessing neurologic and vascular function. The evaluation techniques are organized by anatomical area and include tests for ligaments, meniscus, and patella to isolate potential injuries.
Ortho con
1) A 14-year-old boy was in a motorcycle accident where his left hip hit the ground, causing left hip pain and deformity.
2) Examination and x-rays revealed a posterior dislocation of the left hip.
3) The patient was taken to the operating room for closed reduction of the hip dislocation under general anesthesia with skeletal traction.
Examination of shoulder
This document provides an overview of an examination of the shoulder, including:
1) Anatomy of the shoulder bones, joints, and muscles like the rotator cuff.
2) Traditional steps for examining the shoulder including taking a history, inspecting, palpating, assessing range of motion, and performing special tests.
3) Details on examining range of motion, palpating for tenderness, and performing special tests to identify issues like impingement, rotator cuff tears, and instability.
Slap Tears
This is the presentation that I did for the Teaching Track Lecture I was required to give to complete my Master\'s Project.
SLAP PRODROME -PHYSIOTHERAPEUTICS
This document discusses SLAP lesions of the shoulder. It defines SLAP lesions as injuries to the superior labrum. The etiology of SLAP lesions is controversial but may involve traction from the biceps tendon during throwing motions. People at risk include those with poor scapular control or tight posterior capsules. Physical exams do not conclusively diagnose SLAP lesions. Treatment involves a 3-phase rehabilitation program focusing on the kinetic chain, mobility, and strengthening. Core stability, scapular stabilization, and manual therapy techniques are emphasized. While surgery is an option, adaptive changes in throwers mean repairing anatomy may hinder performance. An integrated approach addressing the whole body is most effective for shoulder pain.
Lesion slap reconocimiento_e_implicancias_para_rh
Superior labral anterior-posterior (SLAP) lesions are common shoulder injuries, especially in overhead athletes. They can cause chronic pain and loss of function if left untreated. This paper reviews the classification, pathomechanics, clinical evaluation, and treatment of SLAP lesions. Making the clinical diagnosis can be challenging, as concomitant injuries like rotator cuff tears are common. A thorough history and physical exam, along with imaging, are important to identify SLAP lesions and associated injuries to guide appropriate treatment.
Pelvic trauma
Pelvic fractures can be life-threatening injuries that require prompt treatment. They account for 3% of all fractures and mortality is as high as 22% depending on the severity of the injury. The pelvis forms a ring structure connecting the sacrum to the two innominate bones. High-energy impacts from motor vehicle accidents are the most common causes of pelvic fractures. Tile and Young-Burgess classifications are used to characterize the fractures and guide treatment. Unstable fractures with hemorrhage require emergency stabilization, usually with an external fixator or pelvic binder, and fluid resuscitation to prevent hypovolemic shock.
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This document discusses the stability of the normal knee and how it is affected by total knee replacement. The normal knee has intrinsic stability from its geometry and menisci, as well as extrinsic stability from ligaments, capsules, and muscles. It demonstrates rotations and translations during motion. Total knee replacement removes articular surfaces and cruciate ligaments, destabilizing the knee. Without properly functioning ligaments after surgery, the knee loses proprioceptive feedback and the range of passive motion increases, disturbing dynamic stabilization. To create good stability, the collateral ligament frame must be maintained without additional releases.
Posterior Instability
This document provides information on posterior instability of the shoulder. It discusses the mechanism of injury, incidence, diagnosis through x-rays, keys to success including portal placement and fixation options. Positioning for repair in beach chair position is described along with portals for posterior stabilization and techniques for suture passing and fixation using suture anchors, suture lassos, and knots. Additional stabilization techniques and potential complications are briefly touched upon.
Acetabular Fractures
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Immobilization and shifting of injured athelete I Dr.RAJAT JANGIR JAIPUR
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Similar to Anatomy and physical exam of the shoulder
Clinical Examination of the Shoulder.pptx
impingement test, Hawkins, rotator cuff, shoulder examination, Neer, Belly, Hornblower, speed's, crank
Shoulder joint examination.pptx by ortho
shoulder joint examination explained in details,
there are all the test mentioned for shoulder joint examination
brief anatomy
also physiology of shoulder joint is explained with relevant pathology
Shoulder pathologies
This document provides an overview of shoulder pathologies and their clinical and radiological assessment. It discusses the anatomy of the shoulder joint and its components. It describes the clinical examination of the shoulder and various special tests to evaluate specific pathologies. It then covers different shoulder conditions like impingement syndrome, rotator cuff tears, labral injuries, arthritis, tumors and instability in detail. For each condition, it discusses etiology, clinical features, imaging findings on radiography, ultrasound, CT and MRI. It provides images to illustrate the typical presentations of various shoulder abnormalities.
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
This document provides guidance on evaluating painful shoulders. It reviews common causes of shoulder pain, including rotator cuff issues, frozen shoulder, instability, arthritis and labral tears. The importance of history and physical exam is emphasized. Key exam techniques like range of motion tests and special tests for specific diagnoses are outlined. Common conditions are then reviewed in detail, covering typical presentations, exam findings, diagnosis and initial treatment approaches. The goal is to improve physician comfort in evaluating and managing common shoulder issues.
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
The document provides guidance on evaluating painful shoulders. It reviews taking a thorough history, performing a physical exam including special tests, and diagnosing and managing common causes of shoulder pain. Key causes discussed include rotator cuff pathology, adhesive capsulitis, shoulder instability, AC joint separation, arthritis, and labral tears. For each, it outlines presenting symptoms, physical exam findings, diagnosis methods, and treatment approaches. The document emphasizes that most shoulder pain can be treated conservatively with rest, physical therapy, and injections before specialist referral is needed.
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
The document provides guidance on evaluating painful shoulders. It reviews taking a thorough history, performing a physical exam including special tests, and diagnosing and managing common causes of shoulder pain. Key causes discussed include rotator cuff pathology, adhesive capsulitis, shoulder instability, AC joint separation, arthritis, and labral tears. For each, it outlines presenting symptoms, physical exam findings, diagnosis methods, and treatment approaches. The document emphasizes that most shoulder pain can be treated conservatively with rest, physical therapy, and injections before specialist referral is needed.
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
The document provides guidance on evaluating painful shoulders. It reviews taking a thorough history, performing a physical exam including special tests, and diagnosing and managing common causes of shoulder pain. Key causes discussed include rotator cuff pathology, adhesive capsulitis, shoulder instability, AC joint separation, arthritis, and labral tears. For each, it outlines presenting symptoms, physical exam findings, diagnosis methods, and treatment approaches. The document emphasizes that most shoulder pain can be treated conservatively with rest, physical therapy, and injections before specialist referral is needed.
Rotator Cuff Evaluation
Rotator Cuff Evaluation
- The document summarizes evaluation and examination of rotator cuff injuries, including descriptions of common tests like the empty can test, Neer's test, and Hawkins-Kennedy test. It also reviews rotator cuff anatomy and covers potential orders and referrals for primary care providers. Examples of shoulder injuries like SLAP tears, Bankart tears, and Drew Brees' shoulder dislocation are examined.
clinicalexaminationofshoulder.pptx
This document provides information on shoulder anatomy, biomechanics, common causes of shoulder pain, physical examination of the shoulder, and special tests used to evaluate shoulder conditions. It describes the bones, joints, muscles, and bursae of the shoulder. Common causes of shoulder pain in adults include impingement syndrome, rotator cuff problems, and athletic injuries. The physical exam involves assessing range of motion, strength, and performing special tests for conditions like rotator cuff tears, labral tears, biceps tendon injuries, instability, and impingement.
Shoulder disloaction
This document discusses anterior recurrent shoulder dislocation. It begins with an introduction stating that the shoulder is one of the most unstable joints and anterior dislocation is the most common type, affecting around 2% of the population. It then covers the anatomy and stabilizing structures of the shoulder joint. It describes the mechanism of injury as anterior dislocation occurring during abduction and external rotation. Classification, risk factors, pathoanatomy, clinical features, investigations, and various surgical and non-surgical treatment options are discussed. Common procedures mentioned include Bankart repair, Laterjet procedure, and remplissage.
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Vertebral applied Anatomy , kyphoscolosis in spinal anaesthesia, applied anatomy of spine , kyphosis, scoliosis, kyphoscolosis
clinical examination of spine
This document provides an overview of the clinical examination of the spine. It discusses the anatomy of the spine and common spinal conditions. The examination involves obtaining a history, inspecting the spine, palpating for tenderness, and assessing range of motion. Special tests like the straight leg raise test help localize pain and diagnose conditions like herniated discs. A neurological exam evaluates muscle strength, sensation, and reflexes to identify abnormalities affecting the spinal cord or nerves. A thorough spinal exam provides important clues for diagnosing underlying spinal problems.
The Painful Adult Shoulder: evidence based history, exam and approach
This document provides an overview of a lecture on evaluating and diagnosing shoulder pain. It discusses taking a history, performing a physical exam including range of motion and provocative tests, and reviewing evidence on the diagnostic accuracy of the exam. Imaging guidelines and options like MRI, ultrasound and X-rays are presented. Common shoulder conditions like impingement, rotator cuff injuries, and adhesive capsulitis are reviewed in terms of symptoms, exam findings, imaging and treatment.
Shoulder orthopedic disorders (dr.farouk)
This document provides an overview of common orthopedic disorders of the shoulder. It begins with learning objectives related to shoulder anatomy, symptoms, causes of shoulder pain, and specific disorders. Key points include definitions of rotator cuff syndrome, impingement syndrome, calcific tendinitis, and frozen shoulder. Causes, clinical features, imaging, and treatment approaches are described for each condition. The focus is on non-surgical management, but surgical options are also outlined.
Shoulder anatomy & examination-2.pptx
This document provides an overview of shoulder anatomy and common shoulder injuries. It begins with brief epidemiology of shoulder pain, noting that shoulder injuries are common in adults ages 40-60. It then details the anatomy of the shoulder joint, including the bones, joints, muscles, nerves and vascular structures. The document outlines common differential diagnoses for shoulder pain and provides guidance on clinical history and physical exam. It concludes with sections on specific shoulder injuries like fractures of the clavicle and proximal humerus, shoulder dislocations, and treatment approaches.
Shoulder impingement syndrome
This document discusses shoulder impingement syndrome, including its history, presentation, diagnostic evaluation, and treatment. It notes that impingement was first described in 1867 and variously characterized in the early 20th century. In 1972, Neer described impingement syndrome and characterized it as being caused by repeated impingement between the rotator cuff/humeral head and acromion. The document outlines the stages of impingement syndrome and types of impingement. It discusses physical exam findings and imaging workup, and notes that treatment involves a trial of conservative measures followed by arthroscopic acromioplasty if unsuccessful.
SHOULDER 2222.pptx
The document provides information on examining the shoulder joint, including:
1) It describes the anatomy of the shoulder joint which involves three bones and three joints.
2) Common shoulder injuries include rotator cuff problems, impingement syndrome, and athletic injuries.
3) The physical exam involves inspection for atrophy or deformity, palpation of bony landmarks and soft tissues, and assessment of range of motion and strength.
4) Special tests examine for issues like instability, impingement, rotator cuff tears, biceps problems, and AC joint pathology.
Shoulder examination
Shoulder examination for orthopedic students; one of the famous lectures of MAMC PG course - over last 6 years.
Shoulder exam studentsandresidents
This document provides an overview of performing a physical examination of the shoulder. It begins with reviewing the relevant anatomy of the shoulder, including the bones, joints, muscles, and bursae. Common differential diagnoses for shoulder pain are listed. The document then details how to perform the physical examination, including inspection, palpation, range of motion testing, strength testing, and special tests. It provides descriptions of how to perform tests for conditions like impingement, rotator cuff tears, biceps tendonitis, AC joint injuries, instability, and labral tears. Tables at the end summarize the sensitivity, specificity, and likelihood ratios of various history and physical exam maneuvers for diagnosing various shoulder conditions.
Scan exam
This document outlines the components and purpose of a scanning examination performed in physical therapy. The scanning exam is used to ensure issues are within the scope of physical therapy and rule out serious pathology. It involves observation of gait and posture, vital signs, functional movement testing, tissue tension testing, palpation, neurological exams, and special tests. The purpose is to detect gross loss of function and movement control in order to guide further physical therapy diagnosis and treatment.
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Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
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Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
Evaluation of the Painful Shoulder Jacklyn Lindsay Quade_0.ppt
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The Painful Adult Shoulder: evidence based history, exam and approach
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5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Anatomy and physical exam of the shoulder
- 1. ANATOMY AND PHYSICAL EXAM 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 pertinent Anatomy • Review Physical Exam
- 4. GRASHEY VIEW
- 8. OUTLET VIEW
- 10. ZANCA VIEW
- 13. SERENDIPITY VIEW
- 14. BENNETT’S VIEW
- 16. ANATOMY ON MRI
- 18. Clinical aplications: - Biceps tendon - 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 point Shoulder 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
- 36. Dr. Oscar Fariñas; Dr. Iván Sáenz. Facultad de Medicina de la Universidad de Barcelona.
- 37. DELTOPECTORAL APPROACH Watch the Video at: https://www.youtube.com/channel/UCqppa1V7WkCjwjOFDClNFkg
- 39. PHYSICAL EXAM
- 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 • Grade strength 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 Sign Hawkins 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 • Speed test • Yergason maneuver • O’Brien test • Popeye sign
- 51. AC JOINT • Cross arm test • Abd-Add test
- 52. SHOULDER INSTABILITY • Aprehension test • 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 • AC joint • 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 Primary Care % 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 -
- 59. GRACIAS …