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Shoulder Join12222224567777899865t .pptx
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- 2. Objectives • Gross anatomyof the shoulder joint • Examination of the shoulder joint • Specified tests regarding shoulder joint
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- 5. • Multi axial •Synovial • Consisting 03 joints -sterno-clavicular -acromio-clavicular -gleno-humeral (ball & socket) • Movement - abduction & adduction - flexion & extension -lateral & medial rotation
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- 8. • Mid clavicle- previous clavicular fractures • Distal clavicle - subluxation of AC joint • Sides - deltoid wasting • Back - supra/infra spinatus wasting Findings ️ ⭐️Winging of scapular
- 9. FEEL • Palpable Joints& bones - sterno-clavicular joint -along the clavicle -acromio-clavicular joint -corocoid process -along scapular spine -medial border of scapular • Palpable muscles & tendons - trapezius -supra & infra spinatus - biceps tendon
- 10. Findings • AC jointtenderness - osteoarthritis • Greater tubercle - impingement -rotator cuff pathology
- 12. MOVE-Active range Flexion/Extension • Tracearc while reaching forward with elbow straight • Normal flexion to 160°-180°, extension to -60° Abduction/Adduction • Trace arc reaching to side with straight arm • Normal range is 0°-180° ️ ⭐️ Impingement syndrome - painful arc about 60-120 degrees of abduction
- 13. Abduction & externalrotation • Should be able to reach to ~C-7 level (prominent bump on C-spine) Adduction & internal rotation • Should be able to reach lower border of scapula (~T7 level)
- 14. • If painor limitation of active movement, assess with passive ROM testing • Grasp humerus, move through flexion/extension, abduction, adduction • Feel for crepitus with hand on shoulder • 🔺Note movements that precipitate pain – pain on active but not passive ROM suggests muscle/tendon problem • 🔺Note limitations in movement – where in arc does it occur? Due to pain or weakness? Symmetric or asymmetric? ( in impingment syndrome painful arc between 60° - 120° in abduction) • Watch scapular motion – look for asymmetry, jerky motion • Wall push-up for scapular winging MOVE - passive range
- 15. Rotator cuff • 4major muscles • Depress humeral head, keep it in contact with glenoid throughout wide range of moment • Supraspinatus – abducts shoulder (to ~80°) • Infraspinatus – external rotation • Teres minor – external rotation • Subscapularis – internal rotation Strength check by asking the patient to push against a resistance
- 16. Supraspinatus • Hold armsat 1:00 and 11:00, abducted 30 ° • Internally rotate so thumbs point down (“empty can”), pt lifts up against resistance. Repeat with thumbs pointed up • Note pain (tendinopathy, partial tear), weakness (tear) • Deltoid is responsible for abduction beyond 70-80 °
- 17. Infraspinatus External Rotation • Fullyadduct arm, flex elbow to 90 °, medially rotate humerus 45 ° (hand at 12:00) • Have pt try to externally rotate while you resist against their forearms • 🔸can check the strength of teres minor to a lesser degree as well
- 18. Subscapularis Posterior (Gerber’s)Lift Off •Pt places hand behind back, palm facing out • Pt lifts hand away from the back • Note pain, weakness Belly Press 🔻when in an inability to reach the back; • Place hands on abdomen, elbows out • Press in on abdomen or keep elbows out while posteriorly directed force is applied to elbows • Positive test if unable to keep elbows out
- 20. Shoulder impingement • 4tendons of the rotator cuff pass under the acromion and coracoacromial ligament and insert in the humeral head • Space between arcromion, coracoacromial ligament and tendons can narrow, causing impingement of tendons (esp supraspinatus) • Due to over use , repetitive overhead activities such as painting,lifting,swimming,tennis. • Causes shoulder pain, esp with reaching overhead • Can lead to bursatitis,tendanitis in future
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- 22. Hawkins-Kennedy test(impingement) • Flex elbowto 90°,abduct the shoulder • Stabilize shoulder with one hand • Forcibly internally rotate shoulder, thumb pointed down • Pain = impingement
- 23. Cross arm/forced flexion(AC joint) Palpation • Palpate point at which distal clavicle articulates with acromion Cross Arm /Forced Flexion • Flex shoulder to 90°, flex elbow, then actively adduct Pain - osteoartheritis
- 24. Apprehension/ Relocation test (Instability) •With patient supine, abduct shoulder 90°, flex elbow 90° • Externally rotate shoulder by moving forearm from perpendicular to parallel with body • Pain or sense of instability with further external rotation is a positive test, indicating anterior shoulder instability • If sypmtoms are relieved with posterior force applied to proximal humerus, that is a positive relocation test and further supports diagnosis • S
- 25. Sulcus sign(instability) • Armhangs relaxed at the side • Pull arm straight down, Ask the patient to use the unaffected hand to grasp the wrist of the involved arm.look for step-off under lateral acromion • Indicates inferior instability
- 26. Summary… • Follow asystematic approch (look,feel,move & special tests) • Compare both sides • Examine joints above & below • Assess neurovavascular status • Direct appropriate imaging
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