Shoulder Examination ppt (PPTminimizer)

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Shoulder Evaluation:

Shoulder Evaluation

Shoulder Injuries :

Shoulder Injuries Soft Tissue: Contusions: shoulder pointer Acute bursitis: subdeltoid, subacromial (impingement) Sprains: AC, SC Strains: rotator cuff, deltoid, pectoralis major Tendonitis: rotator cuff, biceps Structural: Impingement Syndrome Biceps Rupture Brachial plexus: (traction or compression) Thoracic Outlet Syndrome Luxations: GH dislocation; usually anteriorly GH subluxation Multi-directional instability Fractures: Humeral Clavicular Sternum

Anatomy:

Anatomy Bony: Shoulder Girdle: Clavicle, Scapula, Humerus Humerus : bicipital groove, greater/lesser tubercle, head, deltoid tuberosity Scapula : glenoid fossa, acromion process, coracoid process, spine, lateral (axial) border, medial border, supraspinatus fossa, infraspinatus fossa, superior angle, inferior angle C lavicle : acromial end, sternal end Sternum : manubrium, xiphoid process, body

Anatomy:

Anatomy Muscles: Rotator Cuff : Supraspinatus, Infraspinatus, Teres Minor, Subscapularis (SITS) Scapular : Rhomboids (major & minor), Pectoralis Minor, Trapezius, Levator Scapulae, Serratus Anterior (winging scapula/long thoracic nerve) Humeral : Latissimus Dorsi, Triceps, Pectoralis major, Biceps, Deltoid, Coracobrachialis, Teres Major

Anatomy:

Anatomy Ligaments: Acromioclavicular, Coracoclavicular (trapezoid & conoid), Transverse, Sternoclavicular, Corocoacromial, Costoclavicular Joints: Glenohumeral (made for mobility, not stability) Acromioclavicular Sternoclavicular Coracoclavicular Scapulothoracic (not a true joint) Bursa: Subacromial Subdeltoid

Anatomy:

Anatomy Blood Supply: Subclavian artery & vein, Brachial artery Nerve Supply: Cervical Plexus (C1, C2, C3, C4) Brachial Plexus (C5, C6, C7, C8, T1) Axillary Median Musculocutaneous Radial Ulnar

Forces Acting on the Shoulder:

Forces Acting on the Shoulder During the later stages of abduction, the Rotator Cuff muscles provide a downward pull on the humeral head Allows for the humeral head to pass under the acromion unimpeded Deceleration of the humerus in throwing is assisted by eccentric contractions of the infraspinatus & teres minor

Forces Acting on the Shoulder:

Forces Acting on the Shoulder Force Couple – during abduction a force couple exists between the line of pull between the supraspinatus & the deltoid m. group

Scapulothoracic Rhythm (Scapulohumeral):

Scapulothoracic Rhythm (Scapulohumeral) 0-30° All humerus movement – setting phase 30-90° 2:1 humerus abduction: scapula abduct 90°- full abduction 1:1 ratio

Evaluation - History:

Evaluation - History MOI – direction of arm, was it planted on the ground, fall on outstretched arm, land on the tip, was it abducted w/ ext. rotation Location of pain (Can you touch it or is it deep?) Onset (acute vs. chronic) Sounds/Noises Did you feel anything slip? Training Techniques Prior history Pain scale (scale from 1-10) What activities recreates the pain?

Evaluation - Observation:

Evaluation - Observation How is the arm being held? Willingness to move limb? Deformities – are the shoulders square or is there a drop off? Step Deformity? Levels of Shoulders – even, uneven Musculature - Are there any noticeable spasms in the muscles? Bony – Is anything sticking out in an abnormal direction? Discoloration Swelling

Painful Arc:

Painful Arc Pain is absent at the beginning of the ROM but develops near the midrange of a movement and then ceases as this is passed. Pain is caused when a tender tissue is painfully squeezed in the passing of a certain point during the ROM. Best seen in AROM, normally indicates impingement as tissue is pinched between the acromion process and one of the humeral tubercles. Usually occurs between 60-120 º abduction.

Evaluation - Observation:

Evaluation - Observation Level of Scapula – Inferior angle @ T7, superior angle @ T2 Position of Scapula – winging, rotated

Evaluation - Palpation:

Evaluation - Palpation Jugular notch SC joint Clavicle AC joint Coracoid process Humeral head – greater & lesser tuberosity, bicipital groove Scapula – spine, superior angle, medial & lateral border, inferior angle Deltoid Rotator Cuff Pectoralis Major Trapezius Levator Scapulae Rhomboid major/minor Teres major Biceps brachii Triceps brachii Latissimus dorsi Serratus anterior

Evaluation – Stress Tests:

Evaluation – Stress Tests ROM Apley’s Scratch Test Shoulder flexion – neutral to 170-180 ° Shoulder extension – neutral to 50-60 ° Shoulder abduction – neutral to 170-180 ° Shoulder adduction – because of the torso, there is no true adduction Shoulder internal rotation – neutral to 80-90 ° Shoulder external rotation – neutral to 80-90 ° Gerber Lift-off Test

Evaluation – Stress Tests:

Evaluation – Stress Tests AC sprain Shoulder shrugs Compression test Distraction (traction) test Piano Key Sign Rotator Cuff Strain Drop Arm test Empty Can test (Centinella Test) Gerber’s Lift Off test

Evaluation – Stress Tests:

Evaluation – Stress Tests Biceps Tendonitis Yergason’s: Stability of tendon of long head of biceps in bicipital groove Speed’s test: Tendon of long head of biceps; Ludington’s test Impingement Impingement Sign/Neer Impingement: passive flexion Hawkins-Kennedy Impingement Sign: passive internal rotation @ 90° shoulder flexion, elbow at 90° Cross-over test

Evaluation – Stress Tests:

Evaluation – Stress Tests Dislocation Anterior Apprehension test for Anterior GH laxity Relocation test (Jobe’s Relocation test) for Anterior GH laxity Posterior Apprehension test for GH laxity Glenohumeral Glide tests Sulcus sign for interior GH laxity – hollowing out Anterior/Posterior Drawer test Glenoid Labrum Grind test Clunk test O’Brien’s test – SLAP lesion

Evaluation – Stress Tests:

Evaluation – Stress Tests Thoracic Outlet Syndrome – pressure is applied on the trunks & medial cord of the brachial plexus, subclavian artery or subclavian vein Neurological onset: numbness, pain, paresthesia Arterial onset: coldness of skin, pallor, cyanosis in fingers, muscular weakness Venous onset: muscular & joint stiffness, edema, venous engorgement, thrombophlebitis

Evaluation – Stress Tests -  Pulse:

Evaluation – Stress Tests -  Pulse Adson’s: loss of radial pulse (compression of subclavian artery) Caused by ant. scalene muscle & pec. minor Head looks towards abducted (30°) externally rotated shoulder, & elbow extended w/ thumb pointing up; deep breath Allen Test: loss of radial pulse (compression of neurovascular bundle) Caused by the pectoralis minor muscle Head looks away while elbow is flexed (90°) & shoulder abducted (90°); shoulder passively horiz. abducted & ext. rotated

Evaluation – Stress Tests:

Evaluation – Stress Tests Military Brace Position – loss of radial pulse (compression of subclavian artery by costoclavicular structures of shoulder) Humerus extended & abducted 30° while neck & head are hyperextended

Upper Extremity Neurological Exam - Sensory:

Upper Extremity Neurological Exam - Sensory C5 – lateral aspect of shoulder (deltoid), policeman’s patch C6 – lateral elbow, lateral forearm, thumb & index finger C7 – middle finger C8 – 4 th & 5 th fingers, medial forearm T1 – medial elbow, medial humerus

Upper Extremity Neurological Exam - Motor:

Upper Extremity Neurological Exam - Motor C5 – shoulder abduction C6 – elbow flexion, wrist extension C7 – elbow extension, wrist flexion C8 – finger flexion, extension T1 – finger abduction, adduction

Upper Extremity Neurological Exam - Reflex:

Upper Extremity Neurological Exam - Reflex C5 – biceps brachii C6 – brachioradialis C7 – triceps brachii C8 – none T1 – none

Nerves – Branches of C5-T1:

Nerves – Branches of C5-T1 Axillary Musculocutaneous Median Radial Ulnar