Physical Examination of the Shoulder课件.pptVIP

Physical Examination of the Shoulder Lisa Chiou, MD, MPH Primary Care Conference Goals Review some of that anatomy from medical school Discuss common shoulder problems Practice focused physical exam Shoulder pain Common in all age groups Intrinsic disorder (85%) vs referred pain C-spine nerve impingement (disc herniation or spinal stenosis) Peripheral nerve entrapment distal to spinal column (long thoracic, suprascapular) Diaphragm irritation, intrathoracic tumors, and distension of Gleason’s capsule/gall bladder Myocardial ischemia Pancoast tumor Review of shoulder anatomy Bones Scapula Clavicle Humeral head Posterior rib cage Joints Sternoclavicular Acromioclavicular Glenohumeral Scapulothoracic Glenohumeral joint 25% humeral head surface in contact with glenoid Joint space thinning seen with OA Humeral head coverage increased to 75% with glenoid labrum More shoulder anatomy Ligaments Coracoclavicular Acromioclavicular Glenohumeral Superior GH Middle GH Inferior GH Coracohumeral Subacromial bursa Subdeltoid bursa Rotator cuff muscles Supraspinatus, infraspinatus, teres minor, subscapularis Form cuff around humeral head Keep humeral head within joint (counteract deltoid) Abduction, external rotation, internal rotation Shoulder exam #1 Visualize from front and back Asymmetry Pts with rotator cuff tears hold shoulder higher Atrophy Sign of chronic glenohumeral joint pathology Effusions Shoulder joint can hide a lot of fluid Shoulder exam #2 Palpation Along clavicle SC and AC joints Acromion, subacromial region Coracoid process (short head of biceps) Bicipital groove (long head of biceps) Trigger points in neck, trapezius, scapular region Active range of motion Forward flexion Abduction/adduction Painful arc of abduction – sensitive, not specific External rotation Internal rotation Passive range of motion Immobilize the scapula to prevent rotation Use one arm to push down on shoulder Use other arm to do the PROM exercises Abduction Internal and external rotation