The shoulder in 10 minutes[1]

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The shoulder in 10 minutesA guide for GP registrars : 

The shoulder in 10 minutesA guide for GP registrars Samir Dawlatly 11 March 2010 Karis Study Group

Learning Outcomes : 

Learning Outcomes To improve ability to take history and examine patients with a variety of shoulder complaints To appreciate what may be possible within the constraints of the GP consultation

Overview : 

Overview The history Examination Look Feel Move Special tests Investigations When to refer

History : 

History Age and onset of symptoms 20-30% of 60-70 yr olds have cuff tears 50% of >70 yr olds do History of trauma Occupation/hobbies/sports Function

Examples of function questions : 

Examples of function questions Can patient... comfortably place arm at side? sleep on side? eat with utensil Dress tuck in back of shirt? place hand behind head? comb hair; place coin on shelf? place 1 lb. wt on shelf? place 8 lb. wt on shelf? carry 20 lbs. at side? throw underhand? throw overhand? wash back of contra-lateral shoulder? do usual work? do laundry use toilet

Examination - look : 

Examination - look Preferably undressed Asymmetry Muscle wasting Abnormal posture Abnormal scapular-thoracic rhythm

Examination - Feel : 

Examination - Feel Tenderness at: Acromioclavicular joint Subdeltoid bursae Glenohumeral joint Biceps insertion

Examination - Move : 

Examination - Move First check the neck to see if movements reproduce shoulder pain Flexion/extension Lateral flexion rotation

Examination - Move : 

Examination - Move Abduction – away from the body sideways (?fix scapula as well) Flexion – think conductor increasing vol External rotation (and lag) Internal rotation – spinal level

Special tests : 

Special tests What are you testing for? Instability? Impingement? Rotator cuff tears? SLAP lesion (biceps tendon)? Frozen shoulder?

Instability – apprehension test : 

Instability – apprehension test

Impingement – Hawkin’s Test : 

Impingement – Hawkin’s Test

Impingement – Neer’s test : 

Impingement – Neer’s test

Cuff tears - supraspinatus : 

Cuff tears - supraspinatus

Cuff tears - infrapsinatus : 

Cuff tears - infrapsinatus

Cuff tears - subscapularis : 

Cuff tears - subscapularis

SLAP lesions : 

SLAP lesions refers to a detachment lesion of the superior aspect of glenoid labrum, which serves as the insertion of  long head of biceps;     - relatively common injury in throwing atheletes, but may most commonly occur in patients who have fallen or who have received a blow on the shoulder O’Brien’s test

Frozen Shoulder : 

Frozen Shoulder Adhesive Capsulitis of the Shoulder shoulder capsule becomes contracted and thickened;    - dramatic decrease in shoulder ROM;    - usually spontaneous resolution after 1-3 years Restricted internal and external rotation

Investigate or refer : 

Investigate or refer Impingement Inject x 2 then refer Instability Refer to surgeon or physio Rotator cuff tears USS, MRI, refer to physio/surgeon SLAP lesions MRI and refer Frozen shoulder Early injection may help. Refer for physio +/- surgeon if diagnosis uncertain

Thank you : 

Thank you Any comments or questions?

References and websites : 

References and websites meded.ucsd.edu/clinicalmed/joints2.htm http://www.wheelessonline.com/ http://www.youtube.com/profile?user=BJSMVideos#g/u

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