Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
History & Physical
Exam of the Shoulder
DR UTKARSH SHAHI
ASSISTANT PROFESSOR
DEPARTMENT OF ORTHOPEDICS
REVIEW OF SHOULDER ANATOMY
REVIEW OF SHOULDER ANATOMY
 Bones
Scapula
Clavicle
Humeral head
Posterior rib cage
 Joints
Sternoclavicular
Acromi...
GLENOHUMERAL JOINT
 25% humeral head surface in contact with glenoid
 Joint space thinning seen with OA
GLENOHUMERAL JOINT
 Humeral head coverage increased to 75% with glenoid labrum
MORE SHOULDER ANATOMY
 Ligaments
 Coracoclavicular
 Acromioclavicular
 Glenohumeral
 Superior GH
 Middle GH
 Inferi...
ROTATOR CUFF
 Supraspinatus, infraspinatus, teres
minor, subscapularis
 Form cuff around humeral head
 Keep humeral hea...
MUSCLES OF THE ROTATOR CUFF
 The four major muscles of the rotator cuff rotate the humerus and properly orient the
humora...
SHOULDER CONDITIONS
Injury and mechanical derangement.
Congenital and developmental abnormalities.
Infection and inflammat...
HISTORY TAKING
PATIENT DETAILS CHIEF COMPLAINTS
HISTORY OF PRESENT ILLNESS PAST HISTORY
FAMILY HISTORY PERSONAL HISTORY
TR...
COMPLAINTS
PAIN STIFFNESS
SWELLING DEFORMITY
WEAKNESS INSTABILITY
PARASTHESIA LOSS OF FUNCTION
PAIN
Site Time and mode of onset
Severity or Intensity Character or Nature
Progression Referred pain
Aggravating factors R...
SHOULDER PAIN KEY POINTS
 Shoulder pain is a common complaint in primary care
 2nd only to knee pain for referral to Ort...
PAIN
 The extent of reference is governed by a number of factors.
 The depth of the structure beneath the skin.
 The po...
PAINFUL ARC
 This is not a diagnosis but a localising sign.
 There are 4 common causes of a painful arc at the shoulder ...
PAINFUL ARC
 The patient’s arm is passively and actively abducted from the rest
position alongside the trunk. Pain in the...
PAINFUL ARC
 In the evaluation of the active and passive ranges of motion, the
patient can often avoid the painful arc by...
PAINFUL ARC
FOCUSED HISTORY
FOCUSED HISTORY QUESTIONS
 Mechanism of Injury
 Helps predict injured structure
 Example: Fall directly onto anterior/s...
Characteristics of pain
FOCUSED HISTORY QUESTIONS
Night pain when lying on affected side,
muscle atrophy
Rotator cuff tea...
REFERRED PAIN
REFERRED PAIN
 The shoulder is derived from the fifth cervical segment and therefore refers
pain into the C5 dermatome.
...
REFERRED PAIN
 Typically pain of glenohumeral origin is felt in the upper arm, often at
the insertion of the deltoid.
 S...
25
 Consider OTHER sources of referred pain
 Cervical spine – spondylolysis, arthritis, disc disease
 Cardiac - myocard...
INSTABILITY
Time of Onset
•Congenital
•Developmental
•Acquired
Frequency
•Single episode
•Recurrent Aggravating factors
As...
INSTABILITY
 History of instability
 Glenohumeral subluxation or dislocation
 Aggravating factors
 Overhead work, repe...
PARASTHESIA
Aetiology
Mode of
onset
Duration
Site and
Pattern
Progression
Aggravating
and Relieving
Factors
LOSS OF FUNCTION
Mode of onset
• Sudden
• Gradual
Duration
• Congenital
• Chronic
• Acute
Involved region
and function(s)
...
STIFFNESS
Generalised Localised
Locking Ankylosis
SWELLING
Site Shape Size
First notice
Associated Symptoms
•Pain
•Pressure
•Neurological
•Vascular
•Articular
Progression
A...
DEFORMITY
Site
Associated Symptoms
• Neurological
• Vascular
• Articular
Amount of
disability
Time of Onset
• Congenital
•...
WEAKNESS
Site
Generalised
Localised
Type
Pure Motor
Sensorimotor
Muscular
Mixed
Duration
Acute
Chronic
Onset
Sudden
Gradua...
DIFFERENTIAL DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
DIFFERENTIALS IN SHOULDER
 Trauma
 Impingement & Rotator Cuff
 Subcoracoid Impingement
 Outlet (subacromial) Impingeme...
DIFFERENTIALS IN SHOULDER
 Injuries in throwing athlete
 SLAP lesion
 Internal Impingement
 Glenohumeral Internal Rota...
Physical
Examination
General
Examination
Systemic
Examination
Regional
Examination
GENERAL EXAMINATION
Vitals
•Pulse
•Blood Pressure
•Respiratory Rate
•Temperature
Consciousness Orientation Comfort level P...
Systemic
Examination
Respiratory
System
Cardiovascular
System
Gastrointestinal
System
Central Nervous
System
REGIONAL EXAMINATION
• InspectionLOOK
• PalpationFEEL
• Strength TestingMOVE
• Shortening or Lengthening
• Range of Motion...
PHYSICAL EXAM - GENERAL
 Develop a standard routine
 Alleviate the patient's fears
 Adequate exposure - bilateral
 Mal...
EXAMINATION OF THE SHOULDER
1. Observe the patient, front and back.
2. Observe the shoulder.
3. Observe the axilla.
View...
INSPECTION
 Swelling, asymmetry, muscle atrophy, scars, ecchymosis
and any venous distention
 Note posture (e.g., should...
PALPATION
Sternoclavicular
joint
Clavicle
Acromioclavicular
joint
Subacromial
bursa
Coracoid processBicipital groove
Great...
ANTERIOR SHOULDER POSTERIOR SHOULDER
46
Palpation of AC Joint
 Patient's arm at his/her side
 Note swelling, pain, and gapping.
47
Palpation of Bicipital Groove
 Patient sitting, beginning with
the arm straight
 Patient actively flexes biceps
muscl...
RANGE OF MOTION (ROM)
 Evaluate active ROM
 If movement limited by pain, weakness, or tightness, assist
passively
 Lack...
49
RANGE OF MOTION
Movement
Forward flexion
Extension (behind back)
Abduction
Adduction
External rotation*
Internal rotati...
50FORWARD FLEXION
 Arm straight and brought upward
through frontal plane, and move as
far as patient can go above his hea...
51ABDUCTION
 Arm straight
 Hand – palm up (arm supinated)
 ROM measured in degrees as for
forward flexion
52
EXTERNAL AND INTERNAL ROTATION
 Arm at side, elbow flexed to 90° and held at waist
 Examiner externally or internally...
APLEY SCRATCH TEST FOR ER/IR
Internal rotation and adduction
Reach for lower scapula
Compare bilaterally – note level reac...
OTHER MOVEMENTS
 Extension-with arm by the patient’s side, lift the arm back wards
as far as possible.
 Adduction-draw t...
PAINFUL ARC
 In the evaluation of the active and passive ranges of motion, the
patient can often avoid the painful arc by...
56STRENGTH TESTS
Flexion
Extension
STRENGTH TESTS
External rotation
Infraspinatus
Teres minor
Internal rotation
Subscapularis
SPECIAL TESTS
•Empty can test
•Lift off test
•Drop arm test
Rotator cuff
•Neer’s sign
•Hawkin’s test
Impingement tests
•Sp...
59
ROTATOR CUFF
 Empty can test
Supraspinatus
 Lift off test
Subscapularis
60DROP ARM TEST
 Purpose: tears in the rotator cuff, primarily
supraspinatus muscle
 Method: patient abducts (or examine...
GLENOHUMERAL JOINT STABILITY
Anterior Glenohumeral Instability
Apprehension test
Relocation test
Anterior release test
APPREHENSION TEST - SITTING
 90° of abduction
 Examiner applies slight anterior
pressure to humerus and
externally rotat...
APPREHENSION TEST - SUPINE
 Patient in supine position with
affected shoulder at edge of
table, arm abducted 90°
 Examin...
64RELOCATION TEST
 Performed after positive result on
anterior apprehension test
 Patient supine
 Examiner applies post...
ANTERIOR RELEASE TEST
 Patient in supine position, arm
abducted 90°
 Examiner performs Relocation Test,
then releases do...
IMPINGEMENT - NEER’S SIGN
 Patient seated with arm at
side, palm down (pronated)
 Examiner standing
 Examiner stabilize...
IMPINGEMENT - HAWKIN'S TEST
 Patient standing
 Examiner forward flexes
shoulder to 90°, then forcibly
internally rotates...
BICEPS TENDON – SPEED’S TEST
 Forward flex shoulder against
resistance while maintaining
elbow in extension and
forearm i...
LABRAL TEAR (SLAP) - O'BRIEN'S
ACTIVE COMPRESSION TEST
 Patient standing
 Arm forward flexed 90°, adducted 15° to 20° wi...
70LABRAL TEAR - CRANK TEST
 Shoulder elevated to 160° in the
scapular plane
 A gentle axial load is applied
through glen...
DUGA’S TEST
The patient is seated or standing and touches
the contralateral shoulder with the hand of
the 90°-flexed arm o...
PROVISIONAL DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _...
INVESTIGATIONS
DIAGNOSTIC
IMAGING
LABORATORY
TESTS
OTHER
SPECIALIZED
TESTS
DIAGNOSTIC
IMAGING
PLAIN
RADIOGRAPHS
CONTRAST
RADIOGRAPHS
SPECIALIZED
IMAGING
MODALITIES
ULTRASONOGRAPHY
LABORATORY
TESTS
HAEMATOLOGY
SEROLOGY
IMMUNOLOGY
ENZYME
ANALYSIS
SYNOVIAL
FLUID ANALYSIS
OTHER
SPECIALIZED
TESTS
BONE BIPOSY
BONE MINERAL
DENSITOMETRY
DIAGNOSTIC
ARTHROSCOPY
RADIOLOGY OF SHOULDER
RADIOLOGY OF SHOULDER
RADIOLOGY OF SHOULDER
ANTERIOR SHOULDER DISLOCATION SUBCAPITAL HUMERUS FRACTURE
DEFINITIVE DIAGNOSIS
1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ...
CASTS AND SPLINTS FOR SHOULDER
SHOULDER BRACE SHOULDER SPLINT
CASTS AND SPLINTS FOR SHOULDER
SHOULDER IMMOBILIZER SHOULDER SPICA
U SLAB AND HANGING CAST
SHOULDER ARTHROPLASTY PROSTHESIS
REVERSE SHOULDER PROSTHESIS
THE END
THANK YOU
Upcoming SlideShare
Loading in …5
×

119

Share

Download to read offline

PS SESSION : EXAMINATION OF SHOULDER

Download to read offline

This is about the PS session : Examination of Shoulder for GMCA Block 4.4

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

PS SESSION : EXAMINATION OF SHOULDER

  1. 1. History & Physical Exam of the Shoulder DR UTKARSH SHAHI ASSISTANT PROFESSOR DEPARTMENT OF ORTHOPEDICS
  2. 2. REVIEW OF SHOULDER ANATOMY
  3. 3. REVIEW OF SHOULDER ANATOMY  Bones Scapula Clavicle Humeral head Posterior rib cage  Joints Sternoclavicular Acromioclavicular Glenohumeral Scapulothoracic
  4. 4. GLENOHUMERAL JOINT  25% humeral head surface in contact with glenoid  Joint space thinning seen with OA
  5. 5. GLENOHUMERAL JOINT  Humeral head coverage increased to 75% with glenoid labrum
  6. 6. MORE SHOULDER ANATOMY  Ligaments  Coracoclavicular  Acromioclavicular  Glenohumeral  Superior GH  Middle GH  Inferior GH  Coracohumeral  Subacromial bursa  Subdeltoid bursa
  7. 7. ROTATOR CUFF  Supraspinatus, infraspinatus, teres minor, subscapularis  Form cuff around humeral head  Keep humeral head within joint (counter act deltoid)  Abduction, external rotation, internal rotation
  8. 8. MUSCLES OF THE ROTATOR CUFF  The four major muscles of the rotator cuff rotate the humerus and properly orient the humoral head in the glenoid fossa (socket).  The tendons of these four muscles merge, forming a cuff around the glenohumeral joint.  Supraspinatus: abducts the humeral head and acts as a humeral head depressor  Infraspinatus: externally rotates and horizontally extends the humerus  Teres minor: externally rotates and extends the humerus  Subscapularis: internally rotates the humerus
  9. 9. SHOULDER CONDITIONS Injury and mechanical derangement. Congenital and developmental abnormalities. Infection and inflammation. Arthritis and rheumatic disorders. Metabolic and endocrine disorders. Tumours and lesions that mimic them. Neurological disorders and muscle weakness.
  10. 10. HISTORY TAKING PATIENT DETAILS CHIEF COMPLAINTS HISTORY OF PRESENT ILLNESS PAST HISTORY FAMILY HISTORY PERSONAL HISTORY TREATMENT HISTORY NEGATIVE HISTORY
  11. 11. COMPLAINTS PAIN STIFFNESS SWELLING DEFORMITY WEAKNESS INSTABILITY PARASTHESIA LOSS OF FUNCTION
  12. 12. PAIN Site Time and mode of onset Severity or Intensity Character or Nature Progression Referred pain Aggravating factors Relieving factors Any diurnal variation Any seasonal variation
  13. 13. SHOULDER PAIN KEY POINTS  Shoulder pain is a common complaint in primary care  2nd only to knee pain for referral to Ortho or primary care sports medicine  Most common causes in adults (peak ages 40-60)  Subacromial impingement syndrome  Rotator cuff problems  Athletic injuries  Shoulder accounts for 8-13% of athletic injuries  History and examination are keys to diagnosis
  14. 14. PAIN  The extent of reference is governed by a number of factors.  The depth of the structure beneath the skin.  The position of the structure within the dermatome.  The severity of the lesion
  15. 15. PAINFUL ARC  This is not a diagnosis but a localising sign.  There are 4 common causes of a painful arc at the shoulder joint.  All involve soft tissues being pinched between the humerus and the underside of the acromion.  These are:  Supraspinatus (pain on resisted abduction)  Infraspinatus (pain on resisted lateral rotation).  Subscapularis (pain on resisted medial rotation).  Subacromial bursa (pain at extremes of all passive ranges
  16. 16. PAINFUL ARC  The patient’s arm is passively and actively abducted from the rest position alongside the trunk. Pain in the acromioclavicular joint occurs between 140°and 180° of abduction. Increasing abduction leads to increasing compression and contortion in the joint. (In an impingement syndrome or a rotator cuff tear, by comparison, pain symptoms will occur between 70° and 120°.
  17. 17. PAINFUL ARC  In the evaluation of the active and passive ranges of motion, the patient can often avoid the painful arc by externally rotating the arm while abducting it. This increases the clearance between the acromion and the diseased tendinous portion of the rotator cuff, avoiding impingement in the range between 70° and 120°.
  18. 18. PAINFUL ARC
  19. 19. FOCUSED HISTORY
  20. 20. FOCUSED HISTORY QUESTIONS  Mechanism of Injury  Helps predict injured structure  Example: Fall directly onto anterior/superior shoulder  AC joint injury (shoulder separation)  Example: Arm forcefully abducted and externally rotated  subluxation or anterior dislocation  Example: If chronic pain, note activity that triggers pain, such as the cocking phase of throwing or the pull-through phase of swimming
  21. 21. Characteristics of pain FOCUSED HISTORY QUESTIONS Night pain when lying on affected side, muscle atrophy Rotator cuff tear < 30 yo Biomechanical, inflammatory > 45 yo, Hx of trauma Rotator cuff tear - 35% of pts Painful arc (60-120°abduction) Subacromial impingement Pain > 120° abduction Acromioclavicular joint Catching, popping, clicking GH or AC joint arthritis, labral tear
  22. 22. REFERRED PAIN
  23. 23. REFERRED PAIN  The shoulder is derived from the fifth cervical segment and therefore refers pain into the C5 dermatome.  The acromioclavicular joint is a C4 structure and refers pain into the C4 dermatome.  The shoulder is deep and proximal in the C5 dermatome, hence it can potentially refer pain a great distance.  Conversely the acromio-clavicular joint is a superficial structure at the distal end of the dermatome causing it to give rise to accurate, local pain
  24. 24. REFERRED PAIN  Typically pain of glenohumeral origin is felt in the upper arm, often at the insertion of the deltoid.  Severe shoulder problems can cause pain to radiate as far as the radial side of the wrist.  Rotator cuff problems often include pain radiating to upper arm  If pain starts in neck and radiates to shoulder, consider cervical spine disease
  25. 25. 25  Consider OTHER sources of referred pain  Cervical spine – spondylolysis, arthritis, disc disease  Cardiac - myocardial ischemia  Diaphragmatic irritation  Thoracic outlet syndrome  Gallbladder disease  Complex regional pain syndrome (a.k.a, reflex sympathetic dystrophy) REFERRED PAIN
  26. 26. INSTABILITY Time of Onset •Congenital •Developmental •Acquired Frequency •Single episode •Recurrent Aggravating factors Associated symptoms •Pain •Disability •Neurovascular Reducibility •Reducible •Irreducible Associated Illness
  27. 27. INSTABILITY  History of instability  Glenohumeral subluxation or dislocation  Aggravating factors  Overhead work, repetitive movements, sports  Relieving factors/treatments tried  Rest, immobility, medications, other treatments  History of Prior Shoulder Problems or Surgeries
  28. 28. PARASTHESIA Aetiology Mode of onset Duration Site and Pattern Progression Aggravating and Relieving Factors
  29. 29. LOSS OF FUNCTION Mode of onset • Sudden • Gradual Duration • Congenital • Chronic • Acute Involved region and function(s) Progression Associated features
  30. 30. STIFFNESS Generalised Localised Locking Ankylosis
  31. 31. SWELLING Site Shape Size First notice Associated Symptoms •Pain •Pressure •Neurological •Vascular •Articular Progression Any other swelling Reducibility Any discharge •If present •Duration •Regular or intermittent •Character of discharge
  32. 32. DEFORMITY Site Associated Symptoms • Neurological • Vascular • Articular Amount of disability Time of Onset • Congenital • Developmental • Acquired Correctability • Completely correctable • Partially correctable • Incorrectable
  33. 33. WEAKNESS Site Generalised Localised Type Pure Motor Sensorimotor Muscular Mixed Duration Acute Chronic Onset Sudden Gradual Progression Progressive Static Regressive
  34. 34. DIFFERENTIAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  35. 35. DIFFERENTIALS IN SHOULDER  Trauma  Impingement & Rotator Cuff  Subcoracoid Impingement  Outlet (subacromial) Impingement  Calcific Tendonitis  Rotator Cuff Tears  Rotator Cuff Arthropathy  Proximal Biceps Tendonitis  Biceps Subluxation  AC Pathology  Acromio-Clavicular Injuries (AC Separation)  Distal Clavicle Osteolysis  AC Arthritis  Instability  Traumatic Anterior Shoulder Instability (TUBS)  Posterior Instability & Posterior Dislocation  Multidirectional Shoulder Instability (MDI)  Luxatio Erecta
  36. 36. DIFFERENTIALS IN SHOULDER  Injuries in throwing athlete  SLAP lesion  Internal Impingement  Glenohumeral Internal Rotation Deficit (GIRD)  Little Leaguer's Shoulder  Posterior Labral Tear  Degenerative Conditions  Glenohumeral Arthritis  Adhesive Capsulitis (Frozen Shoulder)  Avascular Necrosis of the Shoulder  Scapulothoracic Crepitus  Neurovascular Disorders  Scapular Winging  Suprascapular Neuropathy  Thoracic Outlet Syndrome  Brachial Neuritis (Parsonage-Turner Syndrome)  Quadrilateral Space Syndrome  Scapulothoracic Dyskinesis  Muscle Ruptures  Pectoralis Major Rupture  Deltoid Rupture  Triceps Rupture  Latissimus Dorsi Rupture
  37. 37. Physical Examination General Examination Systemic Examination Regional Examination
  38. 38. GENERAL EXAMINATION Vitals •Pulse •Blood Pressure •Respiratory Rate •Temperature Consciousness Orientation Comfort level Position of Patient Height and Weight General Appearance Pallor Icterus Clubbing Cyanosis Pupillary Reaction Lymphadenopathy Dexterity Anything specific
  39. 39. Systemic Examination Respiratory System Cardiovascular System Gastrointestinal System Central Nervous System
  40. 40. REGIONAL EXAMINATION • InspectionLOOK • PalpationFEEL • Strength TestingMOVE • Shortening or Lengthening • Range of Motion • Regional measurements MEASURE • Depends upon specific region in considerationSPECIAL TESTS
  41. 41. PHYSICAL EXAM - GENERAL  Develop a standard routine  Alleviate the patient's fears  Adequate exposure - bilateral  Males – shirtless  Females – tank top or sports bra  Compare shoulders
  42. 42. EXAMINATION OF THE SHOULDER 1. Observe the patient, front and back. 2. Observe the shoulder. 3. Observe the axilla. View from rear with patient standing straight and look for lateral symmetry, swelling, position of scapula and signs of muscle wasting.
  43. 43. INSPECTION  Swelling, asymmetry, muscle atrophy, scars, ecchymosis and any venous distention  Note posture (e.g., shoulder protraction)  Deformities  Squaring of shoulder - anterior dislocation  Scapular "winging" - shoulder instability and serratus anterior or trapezius dysfunction  Atrophy - supraspinatus or infraspinatus - consider rotator cuff tear, suprascapular nerve entrapment or neuropathy
  44. 44. PALPATION Sternoclavicular joint Clavicle Acromioclavicular joint Subacromial bursa Coracoid processBicipital groove Greater tuberosity Lesser tuberosity Scapula (spinatus muscles) TIP: Start medially at the SC joint, proceed laterally, end posteriorly
  45. 45. ANTERIOR SHOULDER POSTERIOR SHOULDER
  46. 46. 46 Palpation of AC Joint  Patient's arm at his/her side  Note swelling, pain, and gapping.
  47. 47. 47 Palpation of Bicipital Groove  Patient sitting, beginning with the arm straight  Patient actively flexes biceps muscle while examiner provides supination and ER  Examiner palpates the bicipital groove for pain
  48. 48. RANGE OF MOTION (ROM)  Evaluate active ROM  If movement limited by pain, weakness, or tightness, assist passively  Lack of full ROM with active and passive exam is found in adhesive capsulitis and arthropathy  Evaluate bilaterally for comparison
  49. 49. 49 RANGE OF MOTION Movement Forward flexion Extension (behind back) Abduction Adduction External rotation* Internal rotation* Normal range 0-180° 0-40° 0-180° (with palms up) 0-40° 0-45° (arm at side, elbow flexed) 0-55° (arm at side, elbow flexed)
  50. 50. 50FORWARD FLEXION  Arm straight and brought upward through frontal plane, and move as far as patient can go above his head.  0° is defined as straight down at patient's side, & 180° is straight up.
  51. 51. 51ABDUCTION  Arm straight  Hand – palm up (arm supinated)  ROM measured in degrees as for forward flexion
  52. 52. 52 EXTERNAL AND INTERNAL ROTATION  Arm at side, elbow flexed to 90° and held at waist  Examiner externally or internally rotates arm
  53. 53. APLEY SCRATCH TEST FOR ER/IR Internal rotation and adduction Reach for lower scapula Compare bilaterally – note level reached External rotation and abduction Reach for upper scapula Compare bilaterally – note level reached
  54. 54. OTHER MOVEMENTS  Extension-with arm by the patient’s side, lift the arm back wards as far as possible.  Adduction-draw the arm across the anterior chest wall as far as possible.  Circumduction  Shrugging of shoulders
  55. 55. PAINFUL ARC  In the evaluation of the active and passive ranges of motion, the patient can often avoid the painful arc by externally rotating the arm while abducting it. This increases the clearance between the acromion and the diseased tendinous portion of the rotator cuff, avoiding impingement in the range between 70° and 120°.
  56. 56. 56STRENGTH TESTS Flexion Extension
  57. 57. STRENGTH TESTS External rotation Infraspinatus Teres minor Internal rotation Subscapularis
  58. 58. SPECIAL TESTS •Empty can test •Lift off test •Drop arm test Rotator cuff •Neer’s sign •Hawkin’s test Impingement tests •Speed’s testBiceps tendon •O’Brien’s test •Crank test Labral tear •Apprehension Test •Relocation test •Anterior release test Instability tests
  59. 59. 59 ROTATOR CUFF  Empty can test Supraspinatus  Lift off test Subscapularis
  60. 60. 60DROP ARM TEST  Purpose: tears in the rotator cuff, primarily supraspinatus muscle  Method: patient abducts (or examiner passively abducts) arm and then slowly lowers it  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
  61. 61. GLENOHUMERAL JOINT STABILITY Anterior Glenohumeral Instability Apprehension test Relocation test Anterior release test
  62. 62. APPREHENSION TEST - SITTING  90° of abduction  Examiner applies slight anterior pressure to humerus and externally rotates arm  Positive test = patient expresses apprehension
  63. 63. APPREHENSION TEST - SUPINE  Patient in supine position with affected shoulder at edge of table, arm abducted 90°  Examiner externally rotates by pushing forearm posteriorly.  Positive test = patient expresses apprehension
  64. 64. 64RELOCATION TEST  Performed after positive result on anterior apprehension test  Patient supine  Examiner applies posterior force on proximal humerus while externally rotating patient’s arm  Positive test = patient expresses relief
  65. 65. ANTERIOR RELEASE TEST  Patient in supine position, arm abducted 90°  Examiner performs Relocation Test, then releases downward pressure  Positive test = patient expresses pain or instability when the humeral head is released
  66. 66. IMPINGEMENT - NEER’S SIGN  Patient seated with arm at side, palm down (pronated)  Examiner standing  Examiner stabilizes scapula and raises the arm (between flexion and abduction)  Positive test = pain
  67. 67. IMPINGEMENT - HAWKIN'S TEST  Patient standing  Examiner forward flexes shoulder to 90°, then forcibly internally rotates the arm  Positive test = pain in area of superior GH joint or AC joint
  68. 68. BICEPS TENDON – SPEED’S TEST  Forward flex shoulder against resistance while maintaining elbow in extension and forearm in supination  Positive test = tender in bicipital groove (bicipital tendinitis)
  69. 69. LABRAL TEAR (SLAP) - O'BRIEN'S ACTIVE COMPRESSION TEST  Patient standing  Arm forward flexed 90°, adducted 15° to 20° with elbow straight  Full internal rotation so thumb pointing down  Examiner applies downward force on arm - patient resists  Patient externally rotates arm so thumb pointing up  Examiner applies downward force on arm - patient resists  Positive test = Pain or painful clicking elicited with thumb down and decreased or eliminated with thumb up
  70. 70. 70LABRAL TEAR - CRANK TEST  Shoulder elevated to 160° in the scapular plane  A gentle axial load is applied through glenohumeral joint with one hand, while other hand does IR and ER  Positive test = pain, catching, or clicking in the shoulder
  71. 71. DUGA’S TEST The patient is seated or standing and touches the contralateral shoulder with the hand of the 90°-flexed arm of the affected side then attempt to lower the elbow to the chest is made. Acromioclavicular joint pain suggests joint disease (osteoarthritis, instability, disk injury, or infection). A differential diagnosis must exclude anterior subacromial impingement and shoulder dislocation
  72. 72. PROVISIONAL DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  73. 73. INVESTIGATIONS DIAGNOSTIC IMAGING LABORATORY TESTS OTHER SPECIALIZED TESTS
  74. 74. DIAGNOSTIC IMAGING PLAIN RADIOGRAPHS CONTRAST RADIOGRAPHS SPECIALIZED IMAGING MODALITIES ULTRASONOGRAPHY
  75. 75. LABORATORY TESTS HAEMATOLOGY SEROLOGY IMMUNOLOGY ENZYME ANALYSIS SYNOVIAL FLUID ANALYSIS
  76. 76. OTHER SPECIALIZED TESTS BONE BIPOSY BONE MINERAL DENSITOMETRY DIAGNOSTIC ARTHROSCOPY
  77. 77. RADIOLOGY OF SHOULDER
  78. 78. RADIOLOGY OF SHOULDER
  79. 79. RADIOLOGY OF SHOULDER ANTERIOR SHOULDER DISLOCATION SUBCAPITAL HUMERUS FRACTURE
  80. 80. DEFINITIVE DIAGNOSIS 1. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  81. 81. CASTS AND SPLINTS FOR SHOULDER SHOULDER BRACE SHOULDER SPLINT
  82. 82. CASTS AND SPLINTS FOR SHOULDER SHOULDER IMMOBILIZER SHOULDER SPICA
  83. 83. U SLAB AND HANGING CAST
  84. 84. SHOULDER ARTHROPLASTY PROSTHESIS
  85. 85. REVERSE SHOULDER PROSTHESIS
  86. 86. THE END THANK YOU
  • DrRaviGTadha

    May. 6, 2021
  • AroojZameer1

    Mar. 21, 2021
  • xXDrH

    Feb. 1, 2021
  • SamyakJain223

    Dec. 16, 2020
  • RaafatAlHalabi

    Nov. 21, 2020
  • GrahamSamuel1

    Nov. 21, 2020
  • BruhadaPopuri

    Nov. 11, 2020
  • PareshRathava

    Oct. 19, 2020
  • AnuragSharma627

    Sep. 2, 2020
  • MohdMateenPasha

    Jul. 19, 2020
  • VarunKumar1011

    Jul. 5, 2020
  • TasneemMohamed17

    Jun. 22, 2020
  • HelenMorris29

    May. 18, 2020
  • YagnikBhuva

    Jan. 31, 2020
  • Drkannan1

    Jan. 5, 2020
  • GlmGlm

    Dec. 10, 2019
  • LINDAKOSGEI

    Dec. 6, 2019
  • tushaarghodawat31

    Nov. 10, 2019
  • KhadirKhanMA

    Nov. 8, 2019
  • fi2109

    Oct. 10, 2019

This is about the PS session : Examination of Shoulder for GMCA Block 4.4

Views

Total views

12,824

On Slideshare

0

From embeds

0

Number of embeds

38

Actions

Downloads

158

Shares

0

Comments

0

Likes

119

×