clinical assessment of the shoulder - bmus · clinical assessment of the shoulder . shoulder...
TRANSCRIPT
![Page 1: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/1.jpg)
Shoulder anatomy and clinical assessment of the
shoulder
![Page 2: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/2.jpg)
Shoulder anatomy
• Highly mobile joint where stability has been sacrificed for mobility.
• Shoulder girdle comprises: • Glenohumeral (ball and socket) joint
• Acromio-clavicular joint
• Scapula sitting on thoracic wall / rib cage (“floating” joint)
![Page 3: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/3.jpg)
Glenohumeral (ball and socket) joint
Courtesy Nicki Delves
![Page 4: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/4.jpg)
Glenohumeral (ball and socket) joint
Courtesy Nicki Delves
![Page 5: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/5.jpg)
Glenohumeral (ball and socket) joint
Courtesy Nicki Delves
![Page 6: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/6.jpg)
Glenohumeral (ball and socket) joint
Courtesy Nicki Delves
Coraco-acromial ligament (CAL)
![Page 7: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/7.jpg)
Glenohumeral (ball and socket) joint
• Rotator Cuff muscles
![Page 8: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/8.jpg)
Glenohumeral (ball and socket) joint
Courtesy Dr Kai Win
• Rotator Cuff muscles
![Page 9: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/9.jpg)
Subscapularis
Courtesy Nicki Delves
TeachMeAnatomy.info
![Page 10: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/10.jpg)
Supraspinatus
TeachMeAnatomy.info
![Page 11: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/11.jpg)
Infraspinatus
TeachMeAnatomy.info
![Page 12: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/12.jpg)
Bursae
Courtesy Kate Norris & Nikki Meredith
![Page 13: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/13.jpg)
Rotator cuff tendons
Rotator Int
Courtesy Nicki Delves
![Page 14: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/14.jpg)
Biceps tendon in rotator interval
Courtesy Nicki Delves
![Page 15: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/15.jpg)
Biceps tendon in rotator interval
Courtesy Nicki Delves
![Page 16: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/16.jpg)
Rotator interval
Courtesy Nicki Delves
![Page 17: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/17.jpg)
Rotator interval
Courtesy Nicki Delves
![Page 18: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/18.jpg)
Biceps tendon
Courtesy Nicki Delves
![Page 19: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/19.jpg)
Acromio-clavicular joint
© Lydia Kibuk (2000) Courtesy Dr Kai Win
![Page 20: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/20.jpg)
Acromio-clavicular joint
© Lydia Kibuk (2000) Courtesy Dr Kai Win
![Page 21: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/21.jpg)
Acromio-clavicular joint
© Lydia Kibuk (2000) Courtesy Dr Kai Win
![Page 22: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/22.jpg)
Scapula sitting on thoracic wall / rib cage
Fastbleep.com
![Page 23: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/23.jpg)
Scapula sitting on thoracic wall / rib cage
Fastbleep.com Musculoskeletalkey.com
![Page 24: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/24.jpg)
Scapula sitting on thoracic wall / rib cage
![Page 25: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/25.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 26: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/26.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 27: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/27.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 28: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/28.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 29: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/29.jpg)
Instability
Courtesy Nicki Delves
![Page 30: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/30.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 31: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/31.jpg)
Acromio-clavicular joint
© Lydia Kibuk (2000) Courtesy Dr Kai Win
![Page 32: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/32.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 33: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/33.jpg)
Frozen shoulder; GHJ OA
Courtesy Nicki Delves
![Page 34: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/34.jpg)
Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
![Page 35: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/35.jpg)
“Impingement”
Courtesy Nicki Delves
![Page 36: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/36.jpg)
Bursal involvement
Courtesy Kate Norris & Nikki Meredith
![Page 37: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/37.jpg)
Rotator cuff tears
![Page 38: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/38.jpg)
![Page 39: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/39.jpg)
![Page 40: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/40.jpg)
Some orthopaedic tests www.shoulderdoc.co.uk – so far 129 found
• Empty can test • Pain, muscle weakness
• Hawkins Kennedy
• Neer impingement test • Scapular held down, examiner passively
abducts the arm
• ACJ Scarf test
• Others: • Anterior apprehension • Scapular assistance test
• Various rotator cuff tests
![Page 41: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/41.jpg)
“Ask the questions you felt too self-conscious to ask”
• Q. What is the difference between tendinosis and tendinopathy? When do you use the terms in reporting? Symptomatic non symptomatic
• Q. What thickness should Supraspinatus be, age affecting etc
• Q. Should we always comment on impingement?
• The management of certain conditions, post scan, e.g.
1. Calcified tendinopathy, in its varying forms; perhaps comparison of clinical management over barbotage.
2. Adhesive Cap - in its varying stages and when more urgent Physiotherapy fits in.
This can empower the sonographer to gauge the clinical significance of the scan findings and to be able to discuss this in an informed way with the patient.
![Page 42: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/42.jpg)
“Ask the questions you felt too self-conscious to ask”
• does a specific orthopaedic test mean the patient has a particular pathology?
• should I try and reproduce their symptoms when I scan them?
• if they have neck pain then is there any point in scanning them?
• what is actually causing pain at the shoulder?
• is a frozen shoulder the only reason for a stiff shoulder?
• what are the 3 things I should ask before I scan them?
• what are the 3 things I should do to them / ask them to do before I scan them?
• what should I tell them if I find a tear, calcific deposit, etc?
![Page 43: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/43.jpg)
![Page 44: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/44.jpg)
Special Tests – all taken from previous MSK SiG presentation by Eoghan Murray
• ‘‘it is not possible to make a definitive diagnosis with the clinical tests currently in use’’ (Lewis, J & Tennent, D., 2007)
• ‘’Currently, almost without exception, there is a lack of clarity with regard to whether common tests used in clinical examination are useful in differentially diagnosing pathologies of the shoulder’’ (Hegeduset al. 2008)
• No test is absolutely diagnostic of a particular shoulder pathology
•No test series capable of selectively assessing r/c + S.A bursal tissues + integrity of the S.A space
•All clinical tests stretch and/or compress S.A bursae
•Reduce specificity and ability to differentiate
• Difficult to isolate individual tendons and other structures and inform accurate diagnosis:
• –r/c morphology -r/c cable
• –Position + innervation of sub-acromial bursae
• –Lack of correlation between symptoms and imaging, U/S + MRI
•Tests reasonably reliable when used in combination and in context to clinical
![Page 45: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/45.jpg)
Special Tests (cont)
• Validity of the Tests
• Neer72% sensitivity, 60% specificity
• Hawkins Kennedy 79% sensitivity, 59% Specificity
• Painful arc 53% sensitivity, 76% specificity
(Hegaduset al., 2012)
• Impingement Tests:
• –Relatively high sensitivity but low specificity
• –Substantially decreases utility in deriving a specific diagnosis.
• •Not all structural failure correlates with symptoms
• Tests reasonably reliable when used in combination and in context to clinical picture.
•Testing must be used in conjunction with the subjective history
•Combination of tests provides more conclusive diagnosis
![Page 46: Clinical Assessment of the shoulder - BMUS · clinical assessment of the shoulder . Shoulder anatomy ... •Shoulder girdle comprises: •Glenohumeral (ball and socket) joint •Acromio-clavicular](https://reader036.vdocuments.us/reader036/viewer/2022062302/5f0aba357e708231d42d0bbf/html5/thumbnails/46.jpg)
Special Tests (cont): radiological correlation?
• Poor correlation between structural failure and symptoms
•R/C pathology related to age