Shoulder JT 2010

8/9/2019 Shoulder JT 2010

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Anatomy in Action

The Shoulder

Jennifer Thompson MD FRCSI


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HISTORY

• Events leading to injury

• ain

• Stiffness! restri"tion of movement

• #ea$ness e.g. lifting the arm

• %oss of fun"tion• S&elling

• Insta'ility


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PAIN

• INFLAMMATION

- the “-itis !ro"lems•FRA#T$R%

•&ISLO#ATION

- 'leno-humeral

- Acromio-cla(icular


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Anatomical structures commonly

causin) !ain in the shoulder

• Muscle- Myositis! tear

• Tendons

( Tendinitis eg supraspinatus• *ursa

( )ursitis eg su'a"romial

• +oints

( Synovitis* dislo"ation

• Re,erred( from "ervi"al spine

( a'domen* "ardia" -itis


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#auses 'lenohumeral Insta"ility

Anterior dislo"ation se"ondary to+

,- 'lo& to the a'du"ted! e.ternally rotated! ande.tended arm

/- a fall on the outstret"hed hand

0- 'lo& to the posterior humerus

Posterior dislo"ation

,- violent mus"le "ontra"tion 1eg &ith a sei2ure orele"tri" sho"$3

/- re"urrent mi"ro(trauma eg s&immers! thro&ers

0- 'lo& to the anterior shoulder


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%.AMINATION

LOO/

F%%L

MO0%


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%.AMINATION

FIRST OF ALL

%1amine the

nec2


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LOO/

S$RFA#% ANATOMY

• #ontour

• Ali)nment

• 3in)in) o, the sca!ula

M$S#L% *$L/

• &eltoid

• Su!ras!inous ,ossa• In,ras!inous ,ossa

• S3%LLIN'4 *R$ISIN' etc


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#ONTO$R 5 ALLI'NM%NT


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S6ellin) o, the Shoulder

%FF$SION 7,ree ,luid 6ithin the 8oint ca!sule9

- In,lammation

• Acute in,lammatory arthritis

7e) Rheumatoid9

• #rystal arthritis e) 'out

• In,ection o, the 8oint

( Rotator cu,, tear

OR LO#AL S3%LLIN' *$RSITIS

( e) su"acromial


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F%%L

T%N&%RN%SS:

3ARMTH:

S3%LLIN':

&on;t ,or)et the lim" )irdle


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F%%L

Tender sites around the shoulder

4 +oint line )lenohumeral 8oint

acromiocla(icular 8oint

4 Tendons "ici!ital

4 *ursae su"acromial<

su"deltoid


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MO0%Range of movement ( R5M+ record measurements

First acti(e ROM

PAIN? LIMITATION?

Then !assi(e ROMIs there a difference between Active and Passive ROM?

Is there a painful arc?

Muscle stren)th


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Anatomical A"normalities causin)

im!aired shoulder mo(ement• Muscle

4 Degeneration 4 Denervation

• Tendons 4 Tears 4 Tendinitis

• +oint 4 Inflammation 4 Dislo"ation

• *ursa 4 Inflammation


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Ran)e o, Mo(ement o, the

Shoulder

Fle1ion =->?=o

%1tension =-@=o

A"duction =->?=o

Adduction =-=o

Internal rotation =-B=o

%1ternal rotation =-B=o


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Shoulder Ran)e o, Mo(ement


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SP%#IAL #ONSI&%RATIONS

TH% ROTATOR #$FF


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Rotator #u,, Tear

Most are traumati"+• follo&ing a fall onto an outstret"hed arm• lifting a heavy o'je"t

• thro&ing injury

Features+ pain and &ea$ness on

a'du"tion 6 e.ternal rotation

If chronic+ &asting of the supraspinatus 6infraspinatus mus"les


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Mo(ements o, the Rotator #u,,

Supraspinatus+ Abductin 1/783

Infraspinatus+ !"ternal rtatinTeres minor + !"ternal rtatin

Su's"apularis+ Internal rtatin


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Su!ras!inatus Tendon

• #hat is the fun"tion of the supraspinatus mus"le9

( abductin f the shulder

• :o& to e.amine for possi'le tendinitis or tear9

( pain #$r wea%ness n abductin f shulder

Tear+ partial or "omplete

%oss of ,st /77 a'du"tion


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Su!ras!inatus Tendinitis

( a""ounts for ;7< of "al"ifi" tendinitis

( from deposition of hydro.yapatite "rystals

Clini"al features+• Acute $ chrnic pain lateral shulder $ upper arm

• Pain #$& wea%ness n abductin f the shulder

• Painful arc '( ( &)*( (

+Puring beer,- resist addu"tion from s"apularplane in pronation=-the %MPTY #AN T%ST


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%m!ty #an Test

Tests ,or Im!in)ement


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• Neer or “!assi(e !ain,ul arc test> ( passive fle.ion ofthe internally rotated glenohumeral joint &hile preventing

shrugging- Rotator "uff or long head of 'i"eps tendinitis-


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• Ha62ins test 4 &ith shoulder and el'o& fle.ed at ?7@

the "lini"ian internally rotates the shoulder


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• Yocum;s test ( the hand of the affe"ted side

is pla"ed on the shoulder of the patientAs

unaffe"ted shoulder* the el'o& is then

raised &ithout elevation of the shoulder


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Testin) rest o, Rotator #u,,

Resist tennis ,orehand < "ac2hand tests

su"sca!ularis or in,ras!inatus < teres minor4

res!ecti(ely

Additional tests ,or su"sca!ularis

• *elly !ress el"o6 dri,ts !osteriorly i, 6ea2internal rotation

• Push o,, test


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SP%#IAL #ONSI&%RATIONS

TH% *I#%PS T%N&ON


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*ici!ital Tendon

#here is the 'i"ipital tendon lo"ated9

( bicipital grve

#hat are its fun"tions9

& fle"in f the frearm elbw/

& frward elevatin f the shulder

& supinatin f prnated frearm if elbw fle"ed

• Tenderness o(er the "ici!ital tendon ( tender area &ill migrate

&ith 'i"ipital groove as arm is a'du"ted 6 e.ternally rotated-


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&ia)nosis o, *ici!ital Tendinitis

• S!eed;s Test+ pain in the 'i"ipital groove &ith for&ardfle.ion of the shoulder a'out 078 against resistan"e &ith

el'o& e.tended and arm fully supinated


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LOO/4 F%%L4 MO0%

• LOO/ 4 s&elling! mus"le &asting! alignment! 'ruising

• F%%L 4 s&elling! tenderness! &armth! "repitus

• MO0% 4 a"tive and passive R5M* resisted movement

OTH%R

#SM


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Documents

Shoulder JT 2010