4. Palpation :
Begin by palpating the bony
contours and structures of the
shoulder, then palpate any area of
pain.
Beginning medially, at the Sterno-
Clavicular joint, trace the clavicle
laterally with your fingers.
- (A) Acromion
- acromioclavicular j (arrow)
- (B) Coracoid
- (C) Greater tubercle
5. Temperature :
by dorsum of the hands comparing both sides
Tenderness :
Diffuse tenderness ( biogenic infection or inflammatory arthritis )
Localised tenderness ( over acromioclavicular joint as in osteoarthritis or sub laxation )
Crepitus :
During passive motion of glenohumeral joint
7. • Impingement of:
• Subacromial bursa
• Rotator cuff muscles and tendons
• Biceps tendon
• Between
• Acromion
• Coracoacromial ligament
• AC joint
• Coracoid process
• Humeral head
• Rotator cuff tendonosis
Subacromial Impingement Syndrome
8. • Neer’s Sign
• Arm fully pronated and placed in forced flexion
• Trying to impinge subacromial structures with humeral head
• Pain is positive test
Impingement Signs
10. • Hawkin’s Sign
• Arm is forward elevated to 90 degrees, then forcibly
internally rotated
• Trying to impinge subacromial structures with
humeral head
• Pain is positive test
Impingement Signs
11. Empty can test :
• Abduct the patient to 90
degree bring it to 30 degree of
forward elevation ( scapular
plain ) and internal rotation is
done
• We may add resistant
• Pain and weakness indicate
rotator cuff pathology
12. • Partial thickness tear
• Full (Complete) thickness tear
• May be due to:
• Impingement
• Degeneration
• Overuse
• Trauma
• Partial tears
• Conservative
• Complete tears
• Surgery
Rotator Cuff Tear
13. • Abducted arm slowly lowered
• May be able to lower arm slowly to 90° (deltoid function)
• Arm will then drop to side if rotator cuff tear
• Positive test
• patient unable to lower arm further with control
• If able to hold at 90º, pressure on wrist will cause arm to fall
Special test : Drop-Arm Test
14. • External rotation
• Tests RTC muscles that ER the shoulder
• Infraspinatus
• Teres minor
• Arms at the sides
• Elbows flexed to 90 degrees
• Externally rotates arms against resistance
Strength Testing
15. • Injury to long head of biceps tendon
• Typically an overuse injury
• Repetitive (overhead) lifting
• Impingement
Biceps Tendinitis
18. Definition:
Syndrome characterized by progressive painful
loss of both active and passive range of motion
of glenohumeral joint .
Periarthritis shoulder
19. Age: Adults, most commonly between 40 and 60 years old.
Gender: More common in women than men.
Recent shoulder injury: Any shoulder injury or surgery that results in the
need to keep the shoulder from moving (i.e., by using a shoulder brace,
sling, shoulder wrap, etc.). Examples include a rotator cuff tear and
fractures of the shoulder blade, collarbone or upper arm.
Diabetes: Between 10 and 20 percent of individuals with diabetes
mellitus develop periarthritis shoulder.
Who is at risk for developing periarthritis shoulder?
20. Other health diseases and conditions:
Includes stroke, hypothyroidism (underactive thyroid gland),
hyperthyroidism (overactive thyroid gland), Parkinson’s disease and
heart disease. Stroke is a risk factor for periarthritis shoulder because
movement of an arm and shoulder may be limited. Why other diseases
and conditions increase the risk of developing a periarthritis shoulder is
not clear.
21. • Sever Pain that disturb sleep
• Tenderness
• Decrease range of motion
( specially external rotation and
internal rotation )
Symptoms and signs
22. Stages :
• Painful stage :progressive vague pain lasting roughly 8 months .
• Stiffening stage : decreasing ROM lasting roughly 8 months .
• Thawing stage : increasing ROM with decrease of shoulder pain .
23. Treatment
• Rehabilitation
• -restoring passive and active range of motion.
• Decreasing pain.
• -Corticosteroid therapy : subacromial and glenohumeral will
decrease pain to maximize therapy
• Home program : stretches in all ranges
• -Modalities: ultrasound and electrical stimulation
• .Surgical
• -Manipulation under anesthesia may be indicated if there is no
substantial progress after 12 weeks of conservative treatment.
• -Arthroscopic lysis of adhesions _ usually reserved for patients
with IDDM who do not respond to manipulation.
24. Causes of
shoulder pain
• Rotator cuff tendinitis
• Rotator cuff tear
• Subacromial bursitis
• Bicipital tendinitis
• Adhesive capsulits
Periarticular
diseases
2
1
Is one of the most common
causes of shoulder pain
Cervical spine
disease
• Inflamnatory arthritis (RA)
• Gleno-humeral arthritis
• Acromio-clavicular
arthritis
• Septic arthritis
• Fructure
• dislocation
Articular diseases
3
• Brachial plexupathy
• Thoracic outlet syndrome
Neuro vascular
diseases
4
25. Anatomy of elbow joint :
The elbow joint is formed by the
humerus and the two bones of the
forearm, the radius and the ulna
They form 3 articulations:
• Humeroulnar J
• Radiohumeral J
• Radioulnar J
All three share a large common
articular cavity and an extensive
synovial lining.
30. Tinel’s sign :
Tapping over ulnar nerve in cubital
tunnel
+ve sign is : tingling and paresthesia
in ulnar nerve distribution in ulnar
neuropathy at elbow
33. Hand and wrist anatomy :
Wrist joints include:
1. Radiocarpal joint (wrist joint)
2. Distal radioulnar joint.
3. Intercarpal joints.
Hand joints. The joints of the hand
include the metacarpophalangeal
joints (MCPs), the proximal
interphalangeal joints (PIPs) and the
distal interphalangeal joints (DIPs).
36. Palpation
• warmth
• tenerness
• Wrist effusion
• MCP effusion
• PIP and DIP effusion
• Flexor tendonitis
Hand and Wrist Examination
37. Range of movement
• Quick screen: make a fist with thumb out, then extended all fingers.
• MCPs : extension , flexion, abduction and adduction.
• Thumb :
• Flexion, extension, abduction , adduction and circumduction.
• Opposition.
• Wrists
• Flexion
• extension
• Radial and ulnar deviation
• Supination, pronation, circumduction
Hand and Wrist Examination
38. Special tests
• Carpal tunnel syndrome
• Phalen’s sign
• Tinel’s sign
• Thumb abduction test
Hand and Wrist Examination
