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.
Describing some of the most important disorders of the shoulder area: frozen shoulder, biceps tenosynovitis, biceps tendon tear, rotator cuff tear, impingement syndrome, Rotator Cuff Calcified Tendonitis
Describing some of the most important disorders of the shoulder area: frozen shoulder, biceps tenosynovitis, biceps tendon tear, rotator cuff tear, impingement syndrome, Rotator Cuff Calcified Tendonitis
Anatomy and function of the shoulder from my Strength and Conditioning placement at the Sports Institute of Northern Ireland (SINI). Includes humeral, scapular and scapulohumeral movement, stability of the shoulder, possible exercises that may assist in preventing injury or of which may be utilised within a rehab setting, and a brief case study in relation to swimmers' shoulder.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
examination,impingement syndrome,rotator cuff injury,shoulder,shoulder instability
All about orthopaedic shoulder examination. comprehensive ppt with all tests arranged symptom wise
Anatomy and function of the shoulder from my Strength and Conditioning placement at the Sports Institute of Northern Ireland (SINI). Includes humeral, scapular and scapulohumeral movement, stability of the shoulder, possible exercises that may assist in preventing injury or of which may be utilised within a rehab setting, and a brief case study in relation to swimmers' shoulder.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
examination,impingement syndrome,rotator cuff injury,shoulder,shoulder instability
All about orthopaedic shoulder examination. comprehensive ppt with all tests arranged symptom wise
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
GEMC: Upper Extremity Injuries: Shoulder, Elbow and Wrist: Resident TrainingOpen.Michigan
This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/
Pathologic conditions in the shoulder of a throwing athlete frequently represent a breakdown of multiple elements of the shoulder restraint system, both static and dynamic, and also a breakdown in the kinetic chain. Physical therapy and rehabilitation for shoulder injuries should be, with only a few exceptions, the primary treatment for a throwing athlete before operative treatment is considered. Articular-sided partial rotator cuff tears and superior labral tears are common in throwing athletes. Operative treatment for shoulder injuries can be successful when nonoperative measures have failed. Throwing athletes who have a glenohumeral internal rotation deficit have a good response, in most cases, to stretching of the posteroinferior aspect of the capsule. For more studies visit Dr. Millett, orthopedic surgeon, http://drmillett.com/shoulder-studies
clerked a case, presented to 5 orthopaedics professors for end of posting evaluation and here it is,with a thought of sharing online (eventho this is not a good one)
Clinical examination of the spine/back covering the following sections:
INSPECTION
PALPATION
MOVEMENTS
MEASUREMENTS
SPECIAL TESTS
(Neurological examination covered separately in another slideshow : SPINE EXAMINATION - PART 2)
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Shoulder exam studentsandresidents
1. History & Physical
Examination of the Shoulder
Garry W. K. Ho, M.D.
VCU / Fairfax Family Practice
Sports Medicine Fellow
January 2007
2. Objectives
Review pertinent anatomy of
the shoulder
Review differential diagnosis
of shoulder complaints
Review clinical history and
physical examination of the
shoulder
Review common shoulder
injuries & characteristic
physical exam findings
3. Brief Epidemiology
Shoulder pain: a common
complaint in primary care
– 2nd only to knee pain for
specialist referrals
– Most common causes in adults
(peak ages 40-60)
Subacromial impingement
syndrome
Rotator cuff problems
Athletic injuries
– Shoulder: 8-13% of all
athletic injuries
7. Anatomy
Glenohumeral joint
– “Ball and socket” vs
“Golf ball and tee”
– Very mobile
– Price: instability
– 45% of all dislocations
– Joint stability depends
on multiple factors
15. Clinical History
Characterize pain
Location of pain
Night pain
Weakness
Deformity
Instability
Locking / Clicking /
Clunking
Sport / Occupation
Previous treatments
Alleviating / Exacerbating
Acute vs. Chronic
Traumatic vs. Overuse
History of prior injury
23. Range of Motion
Scapular dyskinesis
(Scapulothoracic
dysfuntion)
– Compare scapular
motion through ROM on
both sides
– Wall push-ups
–
–
–
Symmetrical
Smooth
No or minimal winging
24. Strength Testing
Test & compare both sides
Be specific to muscle or
muscle group
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
25. Strength Testing
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
26. Strength Testing
Internal rotation
– Tests RTC muscle that
IR the shoulder
Subscapularis
– Arms at the sides
– Elbows flexed to 90
degrees
– Internally rotates arms
against resistance
– Subscapularis Lift-Off
Test
– Other techniques
27. Strength Testing
Supraspinatus
– “Empty can" test
– Jobe’s Test
– Tests Supraspinatus
– Attempt to isolate from
deltoid
–
–
–
–
–
Positioned sitting
Arms straight out
Elbows locked straight
Thumbs down
Arm at 30 degrees
(in scapular plane)
– Attempts to elevate
arms against resistance
28. Special Provocative Tests
Impingement Signs
Drop-Arm Test
Speed’s Test
Yergason Test
Cross-Arm Adduction
Sulcus Sign
Apprehension test
Relocation test
O’Brien’s Test
Crank test
29. Subacromial Impingement
Syndrome
Impingement of:
– Subacromial bursa
– Rotator cuff muscles and
tendons
– Biceps tendon
Between
–
–
–
–
–
Acromion
Coracoacromial ligament
AC joint
Coracoid process
Humeral head
Rotator cuff tendonosis
30. Impingement Signs
Neer’s Sign
– Arm fully pronated
and placed in forced
flexion
– Trying to impinge
subacromial
structures with
humeral head
– Pain is positive test
31. Impingement Signs
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
32. Rotator Cuff Tear
Partial thickness tear
Full (Complete)
thickness tear
May be due to:
–
–
–
–
Impingement
Degeneration
Overuse
Trauma
Partial tears
– Conservative
Complete tears
– Surgery
33. Rotator Cuff Tear: Drop-Arm Test
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
34. Biceps Tendonosis
Injury to long head
of biceps tendon
Typically an
overuse injury
– Repetitive
(overhead) lifting
– Impingement
35. Biceps Tendonosis: Speed’s Test
Forward flex shoulder
to about 90°
Abduct shoulder to
about 10°
Arm in full supination
Apply downward force
to distal arm
Pain is positive test
Weakness without
pain: muscle
weakness or rupture
36. Biceps Tendonosis: Yergason’s Test
Elbow flexed to 90°
Start in pronated
position
Active supination &
flexion against
resistance
Palpate biceps tendon
Pain or painful pop is
positive test
– Tendonosis
– Subluxation
37. AC Separation
AC Sprain /
Separation
– Typically due to
fall onto tip of
shoulder
(acromion)
– Arm tucked into
side
– Treatment
depends on type
39. AC Joint: Cross-Arm Adduction Test
Arm flexed to 90°
Arm adducted to > 45°
Hyperadduct shoulder
(down on elbow)
Positive test is pain in
AC joint
Watch out for falsepositives
– Where is the pain?
40. Shoulder Instability
Failure to keep humeral
head centered in glenoid
Dislocation
– Complete disruption of
joint congruity or
alignment
Subluxation
– Partial or incomplete
dislocation
Laxity
– Slackness or looseness in
joint
– May be normal or
abnormal
41. Instability: Sulcus Sign
Inferior instability
Arm relaxed in
neutral position
Arm pulled
downward at wrist
Positive test is a
visible sulcus at
infra-acromial area
– Compare to
contralateral side
42. Instability: Apprehension Test
Anterior instability
Shoulder abducted to
90°
Slight stress to humeral
head directed in
anterior direction
While externally
rotating shoulder
Positive test is
apprehension due to
feeling of instability or
impending dislocation
– Beware if false positives
43. Instability: Relocation Test
Anterior instability
After a positive
apprehension
Apply posteriorly
directed force over
externally rotated
humeral head
Positive test is relief
of apprehension
Anterior release test
44. Glenoid Labral Tear
Tear in glenoid labrum
Usually due to instability
SLAP Tear (Superior Labrum
Anterior to Posterior)
– Superior labral tear
– Fall on outstretched hand or
shoulder
– Rotator cuff tendonosis or
tears
Bankart Lesion
– Anterior-inferior labral tear
– Anterior shoulder
dislocation / subluxation
45. O’Brien’s Active Compression Test
Labral, AC, or biceps
pathology
Arm flexed to 90°
Arm cross-arm
adducted 10-15°
Elbow extended
Max pronation
Resist downward force
Positive test if painful
Beware location of pain
– AC
– Biceps
– Internal +/- click
46. O’Brien’s Active Compression Test
For labral
pathology
– Repeat testing
with
– Max supination
– Should be pain
free
47. Labral Tear: Crank Test
Abduct arm to 90120°
Stabilize shoulder
Elbow secured with
one hand
Axially load with
ER / IR at shoulder
Positive test: audible
or painful click /
catch / grind