PHYSICAL EXAMINATION OF THE SHOULDERcme.uthscsa.edu/Presentations/Sports13/011913/1_Physical Exam...

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PHYSICAL EXAMINATION

OF THE SHOULDER

Philip M. Jacobs, M.D.

Clinical Associate ProfessorOrthopaedics UTHSCSA

The San Antonio Orthopaedic Group

Financial Disclosure

Dr. Philip M. Jacobs has no relevant financial relationships with commercial interests to disclose.

This presentation is the intellectual property of the author. Contact them at pmjmd@aol.com forpermission to reprint and/or distribute.

PRICELESS

2012

Ouch 2012

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Bull Wins 2012

Bad Day on Golf Course 2012

Tough Day in Gym2012

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PHYSICAL EXAMINATION

OF THE SHOULDER

Clinical Evaluation

Sport Intensity of participationOffending activityArm position during activity

TRAUMATIC

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ATRAUMATIC

EVALUATION OF PAINFUL SHOULDER

History - TraumaticDefine mechanism of injuryPosition of armAmount of force appliedPoint of force

EVALUATION OF PAINFULSHOULDER

History - AtraumaticLength of symptomsWhat aggravates the pain?What relieves the pain?

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Clinical Evaluation

Pain– Associated with activity– During/After (not disabling)– During/After (disabling)– Activities of daily living

Differential Diagnosis of Shoulder Problems in Athletes

Rotator Cuff or Biceps Tendon– Strain, Tendinitis, Tear

Glenohumeral instabilityGlenohumeral instability with secondary impingementPrimary impingement of the cuff or biceps tendonCalcific TendinitisAcromioclavicular joint pathologyGlenohumeral arthritisCervical spine pathologyThoracic outlet syndromeAdhesive capsulitisSuprascapulararthropathyAngina, lung tumor, gallbladder disease

Physical ExamInspectionPalpationROMMuscle TestingStability TestingSpecial TestsNeurovascular Exam

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Physical Exam

Inspection – Symmetry, AtrophyPalpation– Location/Degree tenderness– Biceps/Bicipital Groove– SupraspinatusInsertion– AC Joint

Physical Exam

ROM – FF, ER, IR– Note discrepancies in AROM vs.

PROM

Physical Exam

Muscle Testing - Rotator Cuff– Supraspinatus – Resistance with

AB 90, FF 30, pronated– Infraspinatus/TM – Resisted ER– Subscapularis – Lift off

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ROTATOR CUFF

SUBSCAPULARIS TESTING

ER LAG TEST

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ER LAG TEST

STABILITY TESTING

Load / Shift TestSulcus SignApprehension / Relocation Test

Load and Shift

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Load and Shift

Sulcus Sign

Apprehension / Relocation

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Special Tests

Impingement– Painful arc of abduction 60-120

degrees– Pain on forced forward flexion– Pain on forcible internal rotation

with 90 degrees forward flexion

Impingement

Special Tests

Cross Arm Adduction – AC JointO’Brien’s TestLabral Entrapment Test MDI / Ligamentous Laxity

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O’Brien’s Test

O’Brien’s Test

Labral Entrapment Test

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MDI / Ligamentous Laxity

Neurovascular Exam

Neuro Exam ( Motor / Sensory)- Distal Exam- Axillary Nerve

Motor – DeltoidSensory – Lateral aspect of

shoulder

Neurovascular Exam

Vascular ExamDistal Pulses – Radial and Ulnar

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THANK YOU