Shoulder Joint examination Overview. Introduction Presentation Examination Anatomy Investigations Injections Key points. A J Chakrabarti FRCS(Orth). Introduction. Shoulder pain is very common Can be Recalcitrant Many get better spontaneously without treatment - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
4 muscles with their tendons acting as a functional unit to maintain the humeral head centered on the glenoid
The Rotator
cuff
Clinical Examination
Look
Feel
Move
Stand
Sit
Lie
Clinical Examination
Inspection
Localising Tenderness
Neck Examination
CxSpNeuro exam
Functional assess
•Elevation
•Impingement
•ER
•IR
•Abduction RPA
•Cuff testing 3 pt
•Biceps
Minimum 10 point Clinical Examination
Inspection
Localising Tenderness
Neck Examination
CxSpNeuro exam
Functional assess
•Elevation
•Impingement
•ER
•IR
•Abduction RPA
•Cuff testing 3 pt
•Biceps
Minimum 10 point examination
Cx Spine Elevation Ext Rotation Supraspinatus
Impingement Internal Rotation
Infraspinatus
Abduction Subscapularis
LHB
Non shoulder Functional Glenohumeral Cuff / muscles
Empty can Impingement
• Positive
Comparative increased pain
No pain But slower
Block
The Hallmarks of common diseases
Cx stiffness/ pain: Cervical spondylosis / Cx disc prolapseElevation restriction: RCT lifting with good armImpingement sign: Bursal/cuff disease or ACJ impingementRestrictions of Global GHJ motion: Capsular contracture of Frozen shoulder or OA GHJLoss of resisted muscle power: RCT or pain inhibitionPainful resisted cuff activity: RCT/ impingementLHB signs: Biceps tendinopathy
Clinical Judgement
Neck
Shoulder
ACJ
BURSA
CUFF
BICEPS
CAPSULE AND JOINT SURFACE
10 point examination
Shoulder Scores of function
Oxford Shoulder Score 48
12 Questions – all relate to shoulder in last 4 wks
0-4 per question. Max score 48/48 = Gd shoulder
Worst,Dressing,Car,Knife,Shopping,Tray
Brush,Usual,Robes,Axilla,Housewk,Night
Does it need an XR?
Yes: If referring for surgical opinion
Yes: If you need it to corroborate your diagnosis
Yes: If possibility of calcific disease
Yes: If need to exclude arthrosis
(The arthrosis of ACJ
The arthrosis of the GHJ)
Yes: If concerned re: malignant disease
What XR’s do I find valuable?
AP30° CaudalAxillary Lateral
Stryker Notch view for GHJ instabilityClavicular views for ACJ instability
“Sourcil” sign
30° Caudal view - useful to gauge 3D anatomy of Acromion
30° Caudal view
Ultrasound examination
Examines the rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres Minor
Long Head Biceps
Bursa / Impingement
Ultrasound examination
DO NOT REQUEST
IN PREFERENCE TO
PLAIN XR FILM
MRI?
Access to the films is the most important
The reports may be misleading.
The MRI has a picture that both clinician and patient can understand
Most useful when:
ACJ impingement a possibility
Other pathologies /multiple pathologies are expected
Limited use without contrast: calcific disease/ instability
Treatments
In all cases Conservative.
Analgesia
Physiotherapy: Pendular exercises
Theraband exercises
Eccentric Deltoid exercises
“eccentric means lengthening during loading”
Steroid injections
Other injections / other treatments
Treatments
Theraband exercises
Steroid Injections
Prep the skin and draw up solution with separate needle to one used to inject.