Shoulder examination ppt
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This document summarizes the steps for examining a patient's shoulder, including inspection from multiple angles to identify scars, swelling, alignment and muscle wasting. It describes palpating various parts of the shoulder joint. Range of motion and special tests are outlined to assess the rotator cuff, impingement, AC joint, biceps, deltoid, serratus anterior and instability. Specific tests described include Neer's sign, Hawkin's sign, Jobe's test, belly-press test, apprehension test and relocation test. The examination provides a thorough evaluation of the shoulder to identify any injuries or limitations.
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Shoulder examination ppt
- 2. Inspection From the front, side and above Scars Shoulder Alignment Swelling Muscle Wasting From behind Scar Shoulder Alignment Scapula Symmetry Muscle Wasting
- 3. Feel Sternoclavicular joint to the acromioclavicular joint and acromion and coracoid process Greater and lesser tuberosity Glenohumeral joint Bicep tendon Spine and border of scapula
- 4. Move Always examine the cervical spine Move both arms at the same time. Active then passive range of movement Quick Screening Test:Arms above the head and behind the back
- 5. Range of Motion Forward flexion: 160 180属 Extension: 40 - 60属 Abduction: 180 Adduction: 45 属 Internal rotation: 60 - 90 属 External rotation: 80 - 90 属 Apley Scratch Test
- 6. Special test Subacromial impingement AC joint Rotator cuff integrity Biceps Deltoid Serratus anterior Instability testing
- 7. Impingement Signs Neers Sign Arm fully pronated and placed in forced flexion Trying to impinge subacromial structures with humeral head Pain is positive test
- 8. Impingement Signs Hawkins Sign Arm is forward elevated to 90 degrees, then forcibly internally rotated Trying to impinge subacromial structures with humeral head Pain is positive test
- 9. AC Joint: Cross-Arm Adduction Test Arm flexed to 90属 Arm adducted to > 45属 Hyperadduct shoulder (down on elbow) Positive test is pain in AC joint
- 10. Rotator Cuff Integrity: Supraspinatus/ Anterosuperior cuff: Jobes test Arm anteriorly flexed at the level of the shoulder Fully pronate the arm into the empty can position Patient should resist downward force applied on the forearm by the examiner Positive finding -> pain or weakness indicates a supraspinatus tendon lesion
- 11. Rotator Cuff Integrity: Posterior cuff(infraspinatus + teres minor) Drop-Arm Test Abducted arm slowly lowered May be able to lower arm slowly to 90属 (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 90尊, pressure on wrist will cause arm to fall
- 12. Rotator Cuff Integrity: Posterior cuff(infraspinatus + teres minor) Other tests Pattes test Hornblowers sign
- 13. Rotator Cuff Integrity: Subscapularis/anteroinferi or cuff: Belly-Press test: Posture: patient is sitting with the hand of the affected arm on the abdomen. Test: patient exerts pressure on the abdomen with the hand until maximal internal rotation. Pay attention to: the patient feels weakness and cannot maintain maximal internal rotation. The elbow drops backwards, and internal rotation is lost. Pressure is exerted by extension of the shoulder and flexion of the wrist
- 14. Other test Gerbers test Internal rotation lag sign
- 15. 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
- 16. Instability: Apprehension Test Anterior instability Shoulder abducted to 90属 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
- 17. Relocation Test Anterior instability After a positive apprehension Apply posteriorly directed force over externally rotated humeral head Positive test is relief of apprehension
- 18. Instability: Anterior release test Release of downward pressure causes pain.
- 19. THANKYOU
Editor's Notes
- #3: A油winged scapula油is associated with damage or a contusion to the long thoracic nerve of the shoulder and / or weakness in the Serratus Anterior muscle
- #5: Active油ROM油means you move a joint through its range of油motion. Passive油ROM油involves someone else moving a joint for you
- #8: Impingement syndrome/painful arc syndrome油is a clinical油syndrome油which occurs when the tendons of the油rotator cuff油muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the油acromion. This can result in pain, weakness and loss of movement at the shoulder
- #10: AC joint=AcromioClavicular joint
- #11: Rotatary cuff= supraspinatus, infraspinatus, teres minor, and Subscapularis
- #17: Apprehension- unpleasant