ANATOMY AND PHYSICAL EXAM OF THE SHOULDER

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Presentation transcript:

ANATOMY AND PHYSICAL EXAM OF THE SHOULDER David Privitera, MD Orthopaedic Surgeon Western New York Sports and Ortho

Location 2619 Culver Rd Suite 2A Across from Wambachs Garden center just off 104 Shared office with Whitbeck Spinal Associates Onsite Xray, MRI, CT RGH EMR

Shoulder Exam Outline The once over Diagnostic Clustering Cervical Scapula Loss of Passive Motion Rotator Cuff LHB/SLAP AC joint Instability

Start with the Neck! ROM Spurling Recreation of Pain

Palpating Basic Glenohumeral Anatomy Clavicle Coracoid AC joint Subacromial Space Long Head of Biceps/LT

Palpation of Anatomy Clavicle Coracoid AC joint Subacromial Space Long Head of Biceps/LT

Look at their Scapula Look for atrophy

Look at their Scapula Trapezial shrug Rhomboid squeeze Scapular dyskinesis Lateral winging

Look at their Scapula Trapezial shrug Rhomboid squeeze Scapular dyskinesis Lateral winging

Look at their Scapula Trapezial shrug Rhomboid squeeze Scapular dyskinesis Scapular Winging Lateral (trapezial/CN XI palsy Lateral winging

Look at their Scapula Trapezial shrug Rhomboid squeeze Scapular dyskinesis Scapular Winging Lateral (trapezial/CN XI palsy Medial (serratus anterior/ long thoracic n palsy) Medial winging

Assess ROM Don’t be fooled by a quick exam!!! loss of ER very notable at forward flexion and at pt’s side Don’t be fooled by a quick exam!!!

Assess ROM (Chronic bilateral glenohumeral dislocations)

Assess ROM Restricted Excessive Passive=Active Passive>Active think DJD, capsulitis, malunion Passive>Active think cuff pathology Excessive Think tissue laxity/MDI, rare subscap Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Assess ROM Active/Passive Forward Flexion Abduction ER at neutral Isolated Abduction ER at 90 IR at 90

Loss of Passive Motion Loss of ER/Abduction Adhesive Capsulitis DJD Anterior/Posterior capsule contractures

Rotator Cuff Supraspinatus in plane Supraspinatus extended plane (anterior cuff)

Rotator Cuff Infraspinatus ER strength

Rotator Cuff Subscapularis Belly Press strength Upper Border Subscapularis Bear Hug

Rotator Cuff Teres Minor/Infraspinatus Hornblower sign

Long Head of Biceps/ Super Labral Complex TTP LHB Yergason Speed O’brien Crank Mayo Shear

Long Head of Biceps/ Super Labral Complex TTP LHB Yergason Speed O’brien Crank Mayo Shear

Long Head of Biceps/ Super Labral Complex TTP LHB Yergason Speed O’brien Crank Mayo Shear

AC symptoms TTP AC joint +AC shear +Cross Body adduction

Anterior Instability Anterior Apprehension + Relocation Anterior Load and shift

Posterior Instability Forward flexion, IR, adduction Jerk Sign Posterior Load & Shift

Multidirectional Instability PE Signs of hyperlaxity (1) extension of the wrist & MCPJ  fingers are parallel to the dorsum of the forearm, (2) passive apposition of thumbs to flexor forearm, (3) hyperextension of the elbows (>10°) (4) hyperextension of the knees (>10°) (5) flexion of trunk with the knees ext palms on the floor (6) Hyperabduction of shoulder Sulcus (Should reduce in ER)

Finish with Neurovascular C5-T2 Median Radial Ulnar Axillary Radial pulse

Thank you