SlideShare a Scribd company logo
1 of 67
Download to read offline
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
1
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
2
AMRITA SCHOOL OF AYURVEDA
Seminar On;
SHOULDER JOINT PAIN-
DIFFRENTIAL DIAGONOSIS
Presented by,
Sholly Elizabeth
Final Year BAMS
Amrita school of ayurveda
Introduction
Shoulder joint is a ball and socket joint between
glenoid cavity of scapula and upper end of
humerus.It is the most freely movable joint.
Shoulder girdle connects the upper limb to axial
skeleton.
Shoulder joint pain is the second most commonest
musculoskeletal pain and responsible for 4-16% of
musculoskeletal complaints.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
3
Anatomy Of Shoulder Joint…
Shoulder joint
comprises of:
• 3 bones
• 3 joints
• 3 groups of muscles
• other structures
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
6
3 Bones are:
• Clavicle
• Humerus
• Scapula
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
7
3 Joints are:
Acromoiclavicular Joint
Sternoclavicular Joint
Glenohumeral Joint
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
8
3 Groups of Muscles:
1.Scapulohumeral Group:
• Supraspinatus
• Infraspinatus
• Teres Minor
• Subscapularis
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
9
3 Groups of Muscles:
cont:-
2.Axioscapular group:
• Rhomboids
• Trapezius
• Serratus anterior
• Levator scapulae
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
10
3 Groups of Muscles:
cont:-
3.Axiohumeral group:
• Pectoralis major
• pectoralis minor
• Lattissimus dorsi
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
11
3 Groups of Muscles:
cont:-
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
12
Other Structures:
• Bursa
• Labrum
• capsule
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
13
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
14
Blood Supply
• Anterior Circumflex Humeral Vessels
• Posterioir Circumflex Humeral Vessels
• Suprascapular Vessels
• Subscapular Vessels
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
15
Nerve Supply
• Axillary Nerve
• Musculocutaneous Nerve
• Subscapular Nerve
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
16
Movements Of Shoulder Joint:
7 Movements
• Flexion
• Extension
• Abduction
• Adduction
• Medial Rotation
• Lateral Rotation
• Circumduction
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
17
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
19
Movements And Muscles
Flexion:
• Pectoralis major
• Deltoid
• Coracobrachilais
• Assisted by biceps
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
20
Movements And Muscles
Cont:-
Extension
• Deltoid
• Teres Major
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
21
Movements And Muscles
Cont:-
Abduction
• Deltoid
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
22
Movements And Muscles
Cont:-
Adduction
• Lattismus Dorsi
• Pectoralis Major
• Coracobrachialis
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
23
Movements And Muscles
Cont:-
Medial Rotation:
• Pectoralis Major
• Deltoid
• Lattissimus Dorsi
• Teres Major
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
24
Movements And Muscles
Cont:-
Lateral Rotation:
• Infraspinatus
• Deltoid
• Teres Major
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
25
Shoulder Pain
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
26
Shoulder pain can be of two types,
1.True /Intrinsic pain
Pain due to any pathologies of shoulder joint.
2.False/Extrinsic/Reffered pain
Pain due to any other structures which are not related to
shoulder.
Eg:Pathologies with:
• Cervical spine
• Intrathoracic lesion(Eg:Pancoast tumor)
• Gallbladder
• Hepatic disesase
• Diaphragmatic disease
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
27
History Taking
H/O:Trauma
Fibromyalgia
Infection
Inflammation
Occupational Hazards
Previous Cervical Disease
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
28
Cont:-
The patient with affected shoulder joint presents
with one or more of the complaints :
a)Pain
b)Swelling
c)Stiffness
d)Deformity and loss of contour
e)Restriction or loss of movements
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
29
Cont:-
CHARACTERISTICS OF PAIN (DD)
a) Bone pain-Penetrating,deep ,dull,worsens at night.
b) Muscular pain-stiffness,aching,agrevated by use of affected
muscles.
c) Tendon pain-Burning pain,not necessarily radiating.
d) Fracture pain-Sharp,stabbing,aggrevated on movements and
releived on rest and splintage.
e) Nerve pain- Shooting,sharp,burning,radiating.
f) Vascular pain-Diffused aching pain,localised,easily definable.
g) Localised pain-Suggests tumor,osteomyelitis,osteonecrosis.
h) Progressive joint pain-Commomly caused by osteoarthritis.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
30
Inspection
Observe the way the patient moves and carries the shoulder.
The upper part of the body should be undressed to inspect the
following from the front,behind,above and from the sides.
• Position of the clavicle.
• Position of scapula.
• Presence of absenlavicce of
swelling or scars.
• Presence or absence of asymmetery.
• Drooping.
• Loss of contour.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
31
Cont:-
Clinical findings
Winging of scapula:
• Instability of Serratus
anterior Or Trapezius
• Dysfunction.
Squaring of shoulder:
• Anterior Dislocation.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
32
Cont:-
Fracture of Clavicle:
• Swelling on the line of clavicle.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
33
Palpation
GHJ Involvement:
a) Place the thumb
over GHJ joint.
b) Apply pressure over it.
c) Make the patient to rotate the humerus internally
and externally.
Pain localised in this region is indicative of
Glenohumeral pathology.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
34
Cont:-
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
35
Palpation of GHJ joint.
Cont:-
Subacromial Bursa:
Examiner should apply direct manual pressure over
subacromial bursa that lies laterally and immediately
to acromion.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
36
Cont:-
Bicipital Tendon:
• Lateral to subacromion bursa.
• Best identified by palpating bicipital grove as the
patient rotates the humerus internally and externally.
• Direct pressure over the tendon may reveal pain
indicative of bicipital tendonitis.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
37
• A grinding sensation (crepitus)
during shoulder movement.
FRACTURE
SCAPULA/ARTHRITIS
• When the arm is abducted with pressure
just below the acromion;it will elicit
tenderness.
PAINFULARC
• Swelling and tenderness can be elicited
just beneath acromion;even without
abduction.
SUB ACROMIAL
BURSITIS
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
38
Cont:-
• Pain below antero-lateral acromial
rim during palpation
ROTATOR CUFF
TEAR
• Dissappearance of greater
tuberosity of humerus.
DISLOCATION
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
39
Cont:-
Examination
Special tests:
1) Crossover test
2) Appleys scratch test
3) Neers impingement test/sign
4) Hawkins Kennedy impingement test/sign
5) Empty can test
6) Speeds test
7) Dugas test
8) Apprehension test
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
40
Cont:-
CROSSOVER TEST
1.Forward flexion to 90degree
2.Horizontal adduction of arm
over the chest.
3.Reproductive pain over the joint suggest ACJ
involvment.
Pain during this manoeuver suggests Inflammation or
Arthritis of the acroioclavicular joint.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
41
Cont:-
APPLEYS SCRATCH TEST
3 Steps;
Stand behind the patient
and ask to scratch over the
opposite shoulder.
1. By reaching opposite shoulder.
2. By reaching behind the neck.
3. By reaching behind the back.
Difficulty with these motions suggest a Rotator
cuff disorder or Adhesive capsulitis.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
42
Cont:-
Neers Test
1. Patient’s arm should be in internal rotation.
2. Examiner should stand on the side of the patient and place
on hand on the patient’s scapula and other hand on the
patient’s arm below the elbow.
3. Examiner should passively flex the shoulder
forward.
Pain during this maneuver indicates Shoulder impingement
syndrome or Rotator cuff tear.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
43
Cont:-
Hawkins Kennedy Test/Impingement Sign
1.Flex the patient’s shoulder
and elbow to 90 degrees
with the palm facing down
2.Then with one hand on
the forearm and one on the
opposite arm ,rotate the
arm internally.
Pain during this manoeuver indicates shoulder
impingement syndrome or rotator cuff tear.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
44
Cont:-
Empty Can Test
1.Elevate the patient’s arm to 90 deg.
2.Internally rotate the arms with the
thumbs pointing down,as if emptying a can.
3.Ask the patient to resist as you place downward
pressure on the arms.
Weakness during this manoeuver indicates
possible Rotator cuff tear.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
45
Cont:-
Speeds Test
1.The examiner places the
patient’s arm in forward
flexion.
2.Then manual resistance is applied
by the examiner in the downward direction.
Pain in the Bicipital groove shows positive
speeds test,suggestive of bicipital tendonitis.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
46
Cont:-
Dugas Test
1.The patient is made to sit.
2.The examiner instructs patient
to reach across body,By placing a
hand on opposite shoulder and
pull their elbow against their chest.
If there is an inability to complete test;it indicates
shoulder dislocation.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
47
Cont:-
Apprehension Test
Mainly to asses anterior stability of shoulder.
Stand behind the patient,
1.Abduct
2.Extent
3.Externally rotate the shoulder
While pushing the head of humerus forward with thumb,
patient strongly resist this manoeuver if there is impending
dislocation.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
48
Disease Pain Radiating Swelling
Affected
ROM
Rotator cuff
tendonitis
Present _ Present Abduction
Adhesive
capsulitis
Present - - Flexion
Abduction
Adduction
Impingement
syndrome
Present Present - Internal
rotation
Bicipital
tendonitis
- Tenderness at
bicipital groove
- External
rotation,
Abduction
Bursitis Present - Tenderness at
deltiod
Abduction
Adduction
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
49
Adhesive Capsulitis/Frozen
Shoulder
Presents with pain associated with marked
restriction of elevation and external rotation.
Commonly associated with DM
and neck radicular radiations.
May follow Bursitis /Tendonitis of the
shoulder or be associated
with Systemic disorders.
Age group
More common in women after 50yrs.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
50
Cont:-
Pathology:
• Capsule of shoulder thickened
• Mild chronic inflammation
• Fibrosis
Characteristics of Pain
• Pain and stiffness usually develop gradually but progress
rapidly in some patients.
• Night pain is often present in affected shoulder and pain may
interfere with sleep.
• Tender on palpation.
• Both active and passive movement restricted.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
51
Cont:-
Diagnosis
• Radiographs of shoulder show osteopenia.
• Diagnosis is typically made
by physical examination.
• If needed,confirmation can be made by
arthrography-limited amount of contrast
material,usually<15ml can be injected under
pressure in to the shoulder joint
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
52
Cont:-
Management
• Physiotherapy provides the foundation of treatment.
• Local injections of glucocorticoids,NSAID’s may also
provide relief of symptoms.
• Slow but forceful injection of contrast material in to the
joint may remove the adhesions and stretch the
capsule,resulting in improving shoulder motion.
• Manipulation under anaesthesia may be helpful in some
patients.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
53
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
54
Rotator Cuff Tendonitis And
Impingement Syndrome
• Subacromial bursitis usually accompanies this
syndrome.
• Symptoms usually appear after injury or
overuse,especially with activities involving
elevation of arm with some degree of forward
flexion.
• Impingement syndrome usually occurs in persons
participating in tennis,swimming or occupations
that require repeated elevation of arm.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
55
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
56
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
57
Cont:-
Etiology
• Tendonitis of the rotator cuff is the major cause.
• Caused by inflammation of tendons.
Evolution of disease-stages
• Oedema and heammorhage of rotator cuff
• Fibrotic thickening
• Rotator cuff degeneration
• Tendon tears
• Bone spurs
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
58
Cont:-
Age group
>40yrs
Characteristics of Pain
• Dull aching pain in shoulder.
• May interfere with sleep.
• Severe pain when arm is actively abducted into an overheal
position.
• Arc between 60 and 120 degree is especially painful.
• Tenderness present over lateral aspect of humeral head just
below acromion.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
59
Cont:-
Diagnosis
• Arthrography
• USG
• MRI
Management
• NSAID’s
• Local glococorticoid injection.
• Physical therapy
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
60
Subacromial Bursitis
• Bursa-Thin walled sac lined
with synovial tissue.
• Functions of bursa:facilitate
movement of tendons and muscles
over bony prominences
• Sub acromial bursa is located between the
undersurface of acromion and humeral head.
• Most common form of bursitis.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
61
Cont:-
Etiology
• Exesccive frictional force from overuse
• Trauma
• Systemic disease[eg:RA;Gout]
• Infection
• Caused by repeated overhead motion and often accompanies
rotator cuff tendonitis
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
62
Cont:-
Age group
40 to 60yrs
Pain
• Pain along the front and side of the
shoulder is the most common symptom.
• Onset of pain may be gradual or sudden.
• May or may be related to trauma.
• Night time pain,especially when sleeping on affected shoulder is
reported.
• May be associated with arthritis, rotator cuff tendoinitis,rotator
cuff tear,cervical radiculopathy etc.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
63
Cont:-
Diagnosis
• Difficult to distinguish
between pain caused by
bursitis or that caused by a rotator cuff injury as both
exhibit similar pain patterns.
• X ray
• MRI
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
64
Cont:-
Treatment
• RICE method:
a)Rest
b)Ice
c)Compression
d)Elevation
• Oral administration of non steroidal
antiinflammatory drugs
• Physical therapy
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
65
Conclusion:
Almost all pathologies of shoulder are presented
with pain.
Proper history taking and examination is needed
for correct diagnosis ,otherwise may lead to
misdiagnosis.
Shoulder joint disease can be excluded if the
patient can raise both his arms above the head and
bring the two palms together.
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
66
05-02-2024
SHOULDER JOINT PAIN -DIFFRENTIAL
DIAGONOSIS
67

More Related Content

Similar to Shoulder Joint - Introduction, Examination,Frozen shoulder #shoulderjoint #jointsof thebody #examination #testsofshoulderjoint#frozenshoulder#shoulder#scapula#clavicle#humerus#bones#bonesofshoulderjoint#Muscles

ch 3 Shoulder Elbow joint.pptx
ch 3 Shoulder Elbow joint.pptxch 3 Shoulder Elbow joint.pptx
ch 3 Shoulder Elbow joint.pptxAhmedFaisal59561
 
Case based learning joints of upper limb
Case based learning joints of upper limbCase based learning joints of upper limb
Case based learning joints of upper limbAbdul Ansari
 
Ankylosing spondylitis UG lecture
Ankylosing spondylitis UG lectureAnkylosing spondylitis UG lecture
Ankylosing spondylitis UG lectureDhananjaya Sabat
 
Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Monis Khan
 
regonal pain (1) (1).pptx..............
regonal  pain (1) (1).pptx..............regonal  pain (1) (1).pptx..............
regonal pain (1) (1).pptx..............azzaelnenaey
 
811_Anatomy-of-shoulder-joint.ppt
811_Anatomy-of-shoulder-joint.ppt811_Anatomy-of-shoulder-joint.ppt
811_Anatomy-of-shoulder-joint.pptSharmisthaDutta16
 
Soft tissue injury of the knee
Soft tissue injury of the kneeSoft tissue injury of the knee
Soft tissue injury of the kneeMONTHER ALKHAWLANY
 
Knee pain
Knee pain Knee pain
Knee pain ferrokid
 
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxCLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxMohamedNainar3
 
Injuries around the shoulder(maheswari)
Injuries around the shoulder(maheswari)Injuries around the shoulder(maheswari)
Injuries around the shoulder(maheswari)Yeswanth Mohan
 
Range of Motion of Upper Limb.pptx
Range of Motion of Upper Limb.pptxRange of Motion of Upper Limb.pptx
Range of Motion of Upper Limb.pptxM. Taqi Ehsani
 
Knee Joint Assessment Tests and Mobilizations
Knee Joint Assessment Tests and MobilizationsKnee Joint Assessment Tests and Mobilizations
Knee Joint Assessment Tests and MobilizationsM Sohail Raza
 
ankylosing spondylitis physiotherapy management
ankylosing spondylitis physiotherapy managementankylosing spondylitis physiotherapy management
ankylosing spondylitis physiotherapy managementNilofarRasheed1
 

Similar to Shoulder Joint - Introduction, Examination,Frozen shoulder #shoulderjoint #jointsof thebody #examination #testsofshoulderjoint#frozenshoulder#shoulder#scapula#clavicle#humerus#bones#bonesofshoulderjoint#Muscles (20)

ch 3 Shoulder Elbow joint.pptx
ch 3 Shoulder Elbow joint.pptxch 3 Shoulder Elbow joint.pptx
ch 3 Shoulder Elbow joint.pptx
 
Case based learning joints of upper limb
Case based learning joints of upper limbCase based learning joints of upper limb
Case based learning joints of upper limb
 
Ankylosing spondylitis UG lecture
Ankylosing spondylitis UG lectureAnkylosing spondylitis UG lecture
Ankylosing spondylitis UG lecture
 
Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care
 
ggg
gggggg
ggg
 
regonal pain (1) (1).pptx..............
regonal  pain (1) (1).pptx..............regonal  pain (1) (1).pptx..............
regonal pain (1) (1).pptx..............
 
M S Examination.pptx
M S Examination.pptxM S Examination.pptx
M S Examination.pptx
 
Musculoskeletal examination
Musculoskeletal examination Musculoskeletal examination
Musculoskeletal examination
 
Painful arch syndrome
Painful arch syndromePainful arch syndrome
Painful arch syndrome
 
Rotator cuff ppt
Rotator cuff  pptRotator cuff  ppt
Rotator cuff ppt
 
Shoulder pathomechanics
Shoulder pathomechanicsShoulder pathomechanics
Shoulder pathomechanics
 
811_Anatomy-of-shoulder-joint.ppt
811_Anatomy-of-shoulder-joint.ppt811_Anatomy-of-shoulder-joint.ppt
811_Anatomy-of-shoulder-joint.ppt
 
Soft tissue injury of the knee
Soft tissue injury of the kneeSoft tissue injury of the knee
Soft tissue injury of the knee
 
Knee pain
Knee pain Knee pain
Knee pain
 
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxCLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
 
Sportsman's hernia
Sportsman's  herniaSportsman's  hernia
Sportsman's hernia
 
Injuries around the shoulder(maheswari)
Injuries around the shoulder(maheswari)Injuries around the shoulder(maheswari)
Injuries around the shoulder(maheswari)
 
Range of Motion of Upper Limb.pptx
Range of Motion of Upper Limb.pptxRange of Motion of Upper Limb.pptx
Range of Motion of Upper Limb.pptx
 
Knee Joint Assessment Tests and Mobilizations
Knee Joint Assessment Tests and MobilizationsKnee Joint Assessment Tests and Mobilizations
Knee Joint Assessment Tests and Mobilizations
 
ankylosing spondylitis physiotherapy management
ankylosing spondylitis physiotherapy managementankylosing spondylitis physiotherapy management
ankylosing spondylitis physiotherapy management
 

Recently uploaded

ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamAkebom Gebremichael
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfSasikiranMarri
 
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
PNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdfPNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdf
PNEUMOTHORAX AND ITS MANAGEMENTS.pdfDolisha Warbi
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisGolden Helix
 
Exploring the Variety of Private Blood Tests in the UK
Exploring the Variety of Private Blood Tests in the UKExploring the Variety of Private Blood Tests in the UK
Exploring the Variety of Private Blood Tests in the UKPrivate GP London
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners
 
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdfDolisha Warbi
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)MohamadAlhes
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfHongBiThi1
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.pptraviapr7
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiGoogle
 
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...MehranMouzam
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxdrashraf369
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxDr. Dheeraj Kumar
 
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfCCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfMyThaoAiDoan
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..AneriPatwari
 
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...sdateam0
 
Hypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxHypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxAkshay Shetty
 
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Dr. Dheeraj Kumar
 
Aditi Jagtap (Daughter of Ranjit Jagtap).pdf
Aditi Jagtap (Daughter of Ranjit Jagtap).pdfAditi Jagtap (Daughter of Ranjit Jagtap).pdf
Aditi Jagtap (Daughter of Ranjit Jagtap).pdfAditi Jagtap Pune
 

Recently uploaded (20)

ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdf
 
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
PNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdfPNEUMOTHORAX   AND  ITS  MANAGEMENTS.pdf
PNEUMOTHORAX AND ITS MANAGEMENTS.pdf
 
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic AnalysisVarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
VarSeq 2.6.0: Advancing Pharmacogenomics and Genomic Analysis
 
Exploring the Variety of Private Blood Tests in the UK
Exploring the Variety of Private Blood Tests in the UKExploring the Variety of Private Blood Tests in the UK
Exploring the Variety of Private Blood Tests in the UK
 
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...
 
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
PULMONARY EDEMA AND  ITS  MANAGEMENT.pdfPULMONARY EDEMA AND  ITS  MANAGEMENT.pdf
PULMONARY EDEMA AND ITS MANAGEMENT.pdf
 
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
Myelin Oligodendrocyte Glycoprotein antibody associated disease (MOGAD)
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.ppt
 
Introduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali RaiIntroduction to Sports Injuries by- Dr. Anjali Rai
Introduction to Sports Injuries by- Dr. Anjali Rai
 
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
Study on the Impact of FOCUS-PDCA Management Model on the Disinfection Qualit...
 
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptxSYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
SYNDESMOTIC INJURY- ANATOMICAL REPAIR.pptx
 
Culture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptxCulture and Health Disorders Social change.pptx
Culture and Health Disorders Social change.pptx
 
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdfCCSC6142 Week 3 Research ethics - Long Hoang.pdf
CCSC6142 Week 3 Research ethics - Long Hoang.pdf
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
 
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...Big Data Analysis Suggests COVID  Vaccination Increases Excess Mortality Of  ...
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...
 
Hypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptxHypersensitivity and its classification .pptx
Hypersensitivity and its classification .pptx
 
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
 
Aditi Jagtap (Daughter of Ranjit Jagtap).pdf
Aditi Jagtap (Daughter of Ranjit Jagtap).pdfAditi Jagtap (Daughter of Ranjit Jagtap).pdf
Aditi Jagtap (Daughter of Ranjit Jagtap).pdf
 

Shoulder Joint - Introduction, Examination,Frozen shoulder #shoulderjoint #jointsof thebody #examination #testsofshoulderjoint#frozenshoulder#shoulder#scapula#clavicle#humerus#bones#bonesofshoulderjoint#Muscles

  • 1. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 1
  • 2. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 2 AMRITA SCHOOL OF AYURVEDA Seminar On; SHOULDER JOINT PAIN- DIFFRENTIAL DIAGONOSIS Presented by, Sholly Elizabeth Final Year BAMS Amrita school of ayurveda
  • 3. Introduction Shoulder joint is a ball and socket joint between glenoid cavity of scapula and upper end of humerus.It is the most freely movable joint. Shoulder girdle connects the upper limb to axial skeleton. Shoulder joint pain is the second most commonest musculoskeletal pain and responsible for 4-16% of musculoskeletal complaints. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 3
  • 5. Shoulder joint comprises of: • 3 bones • 3 joints • 3 groups of muscles • other structures
  • 6. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 6 3 Bones are: • Clavicle • Humerus • Scapula
  • 7. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 7
  • 8. 3 Joints are: Acromoiclavicular Joint Sternoclavicular Joint Glenohumeral Joint 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 8
  • 9. 3 Groups of Muscles: 1.Scapulohumeral Group: • Supraspinatus • Infraspinatus • Teres Minor • Subscapularis 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 9
  • 10. 3 Groups of Muscles: cont:- 2.Axioscapular group: • Rhomboids • Trapezius • Serratus anterior • Levator scapulae 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 10
  • 11. 3 Groups of Muscles: cont:- 3.Axiohumeral group: • Pectoralis major • pectoralis minor • Lattissimus dorsi 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 11
  • 12. 3 Groups of Muscles: cont:- 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 12
  • 13. Other Structures: • Bursa • Labrum • capsule 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 13
  • 14. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 14
  • 15. Blood Supply • Anterior Circumflex Humeral Vessels • Posterioir Circumflex Humeral Vessels • Suprascapular Vessels • Subscapular Vessels 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 15
  • 16. Nerve Supply • Axillary Nerve • Musculocutaneous Nerve • Subscapular Nerve 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 16
  • 17. Movements Of Shoulder Joint: 7 Movements • Flexion • Extension • Abduction • Adduction • Medial Rotation • Lateral Rotation • Circumduction 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 17
  • 18.
  • 19. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 19
  • 20. Movements And Muscles Flexion: • Pectoralis major • Deltoid • Coracobrachilais • Assisted by biceps 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 20
  • 21. Movements And Muscles Cont:- Extension • Deltoid • Teres Major 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 21
  • 22. Movements And Muscles Cont:- Abduction • Deltoid 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 22
  • 23. Movements And Muscles Cont:- Adduction • Lattismus Dorsi • Pectoralis Major • Coracobrachialis 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 23
  • 24. Movements And Muscles Cont:- Medial Rotation: • Pectoralis Major • Deltoid • Lattissimus Dorsi • Teres Major 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 24
  • 25. Movements And Muscles Cont:- Lateral Rotation: • Infraspinatus • Deltoid • Teres Major 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 25
  • 26. Shoulder Pain 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 26
  • 27. Shoulder pain can be of two types, 1.True /Intrinsic pain Pain due to any pathologies of shoulder joint. 2.False/Extrinsic/Reffered pain Pain due to any other structures which are not related to shoulder. Eg:Pathologies with: • Cervical spine • Intrathoracic lesion(Eg:Pancoast tumor) • Gallbladder • Hepatic disesase • Diaphragmatic disease 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 27
  • 28. History Taking H/O:Trauma Fibromyalgia Infection Inflammation Occupational Hazards Previous Cervical Disease 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 28
  • 29. Cont:- The patient with affected shoulder joint presents with one or more of the complaints : a)Pain b)Swelling c)Stiffness d)Deformity and loss of contour e)Restriction or loss of movements 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 29
  • 30. Cont:- CHARACTERISTICS OF PAIN (DD) a) Bone pain-Penetrating,deep ,dull,worsens at night. b) Muscular pain-stiffness,aching,agrevated by use of affected muscles. c) Tendon pain-Burning pain,not necessarily radiating. d) Fracture pain-Sharp,stabbing,aggrevated on movements and releived on rest and splintage. e) Nerve pain- Shooting,sharp,burning,radiating. f) Vascular pain-Diffused aching pain,localised,easily definable. g) Localised pain-Suggests tumor,osteomyelitis,osteonecrosis. h) Progressive joint pain-Commomly caused by osteoarthritis. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 30
  • 31. Inspection Observe the way the patient moves and carries the shoulder. The upper part of the body should be undressed to inspect the following from the front,behind,above and from the sides. • Position of the clavicle. • Position of scapula. • Presence of absenlavicce of swelling or scars. • Presence or absence of asymmetery. • Drooping. • Loss of contour. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 31
  • 32. Cont:- Clinical findings Winging of scapula: • Instability of Serratus anterior Or Trapezius • Dysfunction. Squaring of shoulder: • Anterior Dislocation. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 32
  • 33. Cont:- Fracture of Clavicle: • Swelling on the line of clavicle. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 33
  • 34. Palpation GHJ Involvement: a) Place the thumb over GHJ joint. b) Apply pressure over it. c) Make the patient to rotate the humerus internally and externally. Pain localised in this region is indicative of Glenohumeral pathology. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 34
  • 35. Cont:- 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 35 Palpation of GHJ joint.
  • 36. Cont:- Subacromial Bursa: Examiner should apply direct manual pressure over subacromial bursa that lies laterally and immediately to acromion. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 36
  • 37. Cont:- Bicipital Tendon: • Lateral to subacromion bursa. • Best identified by palpating bicipital grove as the patient rotates the humerus internally and externally. • Direct pressure over the tendon may reveal pain indicative of bicipital tendonitis. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 37
  • 38. • A grinding sensation (crepitus) during shoulder movement. FRACTURE SCAPULA/ARTHRITIS • When the arm is abducted with pressure just below the acromion;it will elicit tenderness. PAINFULARC • Swelling and tenderness can be elicited just beneath acromion;even without abduction. SUB ACROMIAL BURSITIS 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 38 Cont:-
  • 39. • Pain below antero-lateral acromial rim during palpation ROTATOR CUFF TEAR • Dissappearance of greater tuberosity of humerus. DISLOCATION 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 39 Cont:-
  • 40. Examination Special tests: 1) Crossover test 2) Appleys scratch test 3) Neers impingement test/sign 4) Hawkins Kennedy impingement test/sign 5) Empty can test 6) Speeds test 7) Dugas test 8) Apprehension test 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 40
  • 41. Cont:- CROSSOVER TEST 1.Forward flexion to 90degree 2.Horizontal adduction of arm over the chest. 3.Reproductive pain over the joint suggest ACJ involvment. Pain during this manoeuver suggests Inflammation or Arthritis of the acroioclavicular joint. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 41
  • 42. Cont:- APPLEYS SCRATCH TEST 3 Steps; Stand behind the patient and ask to scratch over the opposite shoulder. 1. By reaching opposite shoulder. 2. By reaching behind the neck. 3. By reaching behind the back. Difficulty with these motions suggest a Rotator cuff disorder or Adhesive capsulitis. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 42
  • 43. Cont:- Neers Test 1. Patient’s arm should be in internal rotation. 2. Examiner should stand on the side of the patient and place on hand on the patient’s scapula and other hand on the patient’s arm below the elbow. 3. Examiner should passively flex the shoulder forward. Pain during this maneuver indicates Shoulder impingement syndrome or Rotator cuff tear. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 43
  • 44. Cont:- Hawkins Kennedy Test/Impingement Sign 1.Flex the patient’s shoulder and elbow to 90 degrees with the palm facing down 2.Then with one hand on the forearm and one on the opposite arm ,rotate the arm internally. Pain during this manoeuver indicates shoulder impingement syndrome or rotator cuff tear. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 44
  • 45. Cont:- Empty Can Test 1.Elevate the patient’s arm to 90 deg. 2.Internally rotate the arms with the thumbs pointing down,as if emptying a can. 3.Ask the patient to resist as you place downward pressure on the arms. Weakness during this manoeuver indicates possible Rotator cuff tear. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 45
  • 46. Cont:- Speeds Test 1.The examiner places the patient’s arm in forward flexion. 2.Then manual resistance is applied by the examiner in the downward direction. Pain in the Bicipital groove shows positive speeds test,suggestive of bicipital tendonitis. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 46
  • 47. Cont:- Dugas Test 1.The patient is made to sit. 2.The examiner instructs patient to reach across body,By placing a hand on opposite shoulder and pull their elbow against their chest. If there is an inability to complete test;it indicates shoulder dislocation. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 47
  • 48. Cont:- Apprehension Test Mainly to asses anterior stability of shoulder. Stand behind the patient, 1.Abduct 2.Extent 3.Externally rotate the shoulder While pushing the head of humerus forward with thumb, patient strongly resist this manoeuver if there is impending dislocation. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 48
  • 49. Disease Pain Radiating Swelling Affected ROM Rotator cuff tendonitis Present _ Present Abduction Adhesive capsulitis Present - - Flexion Abduction Adduction Impingement syndrome Present Present - Internal rotation Bicipital tendonitis - Tenderness at bicipital groove - External rotation, Abduction Bursitis Present - Tenderness at deltiod Abduction Adduction 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 49
  • 50. Adhesive Capsulitis/Frozen Shoulder Presents with pain associated with marked restriction of elevation and external rotation. Commonly associated with DM and neck radicular radiations. May follow Bursitis /Tendonitis of the shoulder or be associated with Systemic disorders. Age group More common in women after 50yrs. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 50
  • 51. Cont:- Pathology: • Capsule of shoulder thickened • Mild chronic inflammation • Fibrosis Characteristics of Pain • Pain and stiffness usually develop gradually but progress rapidly in some patients. • Night pain is often present in affected shoulder and pain may interfere with sleep. • Tender on palpation. • Both active and passive movement restricted. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 51
  • 52. Cont:- Diagnosis • Radiographs of shoulder show osteopenia. • Diagnosis is typically made by physical examination. • If needed,confirmation can be made by arthrography-limited amount of contrast material,usually<15ml can be injected under pressure in to the shoulder joint 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 52
  • 53. Cont:- Management • Physiotherapy provides the foundation of treatment. • Local injections of glucocorticoids,NSAID’s may also provide relief of symptoms. • Slow but forceful injection of contrast material in to the joint may remove the adhesions and stretch the capsule,resulting in improving shoulder motion. • Manipulation under anaesthesia may be helpful in some patients. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 53
  • 54. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 54
  • 55. Rotator Cuff Tendonitis And Impingement Syndrome • Subacromial bursitis usually accompanies this syndrome. • Symptoms usually appear after injury or overuse,especially with activities involving elevation of arm with some degree of forward flexion. • Impingement syndrome usually occurs in persons participating in tennis,swimming or occupations that require repeated elevation of arm. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 55
  • 56. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 56
  • 57. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 57
  • 58. Cont:- Etiology • Tendonitis of the rotator cuff is the major cause. • Caused by inflammation of tendons. Evolution of disease-stages • Oedema and heammorhage of rotator cuff • Fibrotic thickening • Rotator cuff degeneration • Tendon tears • Bone spurs 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 58
  • 59. Cont:- Age group >40yrs Characteristics of Pain • Dull aching pain in shoulder. • May interfere with sleep. • Severe pain when arm is actively abducted into an overheal position. • Arc between 60 and 120 degree is especially painful. • Tenderness present over lateral aspect of humeral head just below acromion. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 59
  • 60. Cont:- Diagnosis • Arthrography • USG • MRI Management • NSAID’s • Local glococorticoid injection. • Physical therapy 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 60
  • 61. Subacromial Bursitis • Bursa-Thin walled sac lined with synovial tissue. • Functions of bursa:facilitate movement of tendons and muscles over bony prominences • Sub acromial bursa is located between the undersurface of acromion and humeral head. • Most common form of bursitis. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 61
  • 62. Cont:- Etiology • Exesccive frictional force from overuse • Trauma • Systemic disease[eg:RA;Gout] • Infection • Caused by repeated overhead motion and often accompanies rotator cuff tendonitis 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 62
  • 63. Cont:- Age group 40 to 60yrs Pain • Pain along the front and side of the shoulder is the most common symptom. • Onset of pain may be gradual or sudden. • May or may be related to trauma. • Night time pain,especially when sleeping on affected shoulder is reported. • May be associated with arthritis, rotator cuff tendoinitis,rotator cuff tear,cervical radiculopathy etc. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 63
  • 64. Cont:- Diagnosis • Difficult to distinguish between pain caused by bursitis or that caused by a rotator cuff injury as both exhibit similar pain patterns. • X ray • MRI 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 64
  • 65. Cont:- Treatment • RICE method: a)Rest b)Ice c)Compression d)Elevation • Oral administration of non steroidal antiinflammatory drugs • Physical therapy 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 65
  • 66. Conclusion: Almost all pathologies of shoulder are presented with pain. Proper history taking and examination is needed for correct diagnosis ,otherwise may lead to misdiagnosis. Shoulder joint disease can be excluded if the patient can raise both his arms above the head and bring the two palms together. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 66
  • 67. 05-02-2024 SHOULDER JOINT PAIN -DIFFRENTIAL DIAGONOSIS 67

Editor's Notes

  1. 11 muscles