physical examination of the shoulder -...
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![Page 1: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/1.jpg)
Physical examination of the shoulder
![Page 2: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/2.jpg)
contents
1. Shoulder anatomy
2. Inspection
3. Bony palpation
4. Soft tissue palpation
![Page 3: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/3.jpg)
Shoulder joint의 구성
type of joint - ball and socket joint,
degree of freedom : 3 - flexion/extension, abd/add, ext/int rot, circumduction
![Page 4: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/4.jpg)
http://pivotalphysio.com/wp-content/uploads/2014/07/ball-and-socket-joint.png
![Page 5: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/5.jpg)
http://teachmeanatomy.info/wp-content/uploads/2013/02/proximal-portion-of-the-humerus-anatomical-landmarks-labelled.png
Shoulder joint의 구성
![Page 6: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/6.jpg)
http://www.eorthopod.com/shoulder-anatomy/topic/78
Shoulder joint의 구성
![Page 7: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/7.jpg)
http://www.orthopaedicsurgeon.com.sg/wp-content/uploads/2011/10/shoulder-anatomy.jpg
Shoulder joint의 구성
![Page 8: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/8.jpg)
Shoulder girdle의 구성
http://www.eorthopod.com/shoulder-anatomy/topic/78
![Page 9: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/9.jpg)
시진(inspection)
* 보행 시 팔 흔드는 동작
* 옷을 벗을 때 어깨 움직이는 것.
* blebs(수포), discoloration(변색),
abrasions(찰상), scar(반흔)
* 과거나 현재의 병변징후(sign of pathology)
* 양쪽 부위 비교 ⇒ asymmetry(비대칭)
![Page 10: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/10.jpg)
시진 – anterior part
1. Clavicle(빗장뼈)
- 역할 ⇒ 어깨뼈 유지,
어깨관절오목(glenoid fossa) 전방 회전 방지
- 위치 ⇒ Sternum(복장뼈)의 흉골병(Manubrium) ~ acromion (봉우리)
2. 세모근 부위
⇒ 어깨가 둥근 것, acromion~greater tuberosity
세모근(Deltoid) athropy 有, 無
3. Shoulder dislocation
![Page 11: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/11.jpg)
시진 – anterior part
http://meded.ucsd.edu/clinicalmed/shoulder_anterior.jpg
![Page 12: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/12.jpg)
시진 – anterior part
http://eorif.com/sites/default/files/Axillary-NPal.jpg
![Page 13: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/13.jpg)
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시진 – posterior part
1. Scapular(어깨뼈)
- 위치⇒ Rib2 ~ Rib7 사이 극돌기(spinous process)에서 약 5∼7.5cm Triangulaura area → T3 spinous process 마주봄.
2. Serratus anterior (앞톱니근) 위축 or 쇠약 ⇒ Winging scapular
3. 어깨뼈 비대칭⇒ ⇒ sprengel's deformity
![Page 16: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/16.jpg)
시진 – posterior part
http://meded.ucsd.edu/clinicalmed/shoulder_posterior.jpg
![Page 17: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/17.jpg)
시진 – posterior part
http://www.shoulderdoc.co.uk/images/uploaded/serratus%20anterior1.jpg http://crossfitlakeland.com/wp-content/uploads/2013/04/tumblr_lfshdl9SJy1qb8tcvo1_5001-630x441.jpg
![Page 18: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/18.jpg)
시진 – posterior part
http://www.specialistphysio.com/library/Right%20Sprengel's%20deformity.jpg
![Page 19: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/19.jpg)
뼈의 촉진(bony palpation)
![Page 20: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/20.jpg)
뼈의 촉진(bony palpation)
![Page 21: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/21.jpg)
뼈의 촉진(bony palpation)
![Page 22: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/22.jpg)
뼈의 촉진(bony palpation)
![Page 23: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/23.jpg)
Clinical Zone에 의한 soft tissue palpation
* 특수한 병변, 임상적 의미를 내포한다. * 임상구역 ⇒ ① 근육둘레띠. ② 봉우리밑 및 세모근 밑 점액낭 ③ 겨드랑이 ④ 팔이음뼈의 돌출 근육
* 목 적 ⇒ ① 정상상태 입증을 위해.
② 해부학적 병변이 있는지 알기 위해.
③ 혹이나 덩어리 같은 병변을 발견하기 위해
: 근육 긴장도, 경도, 크기, 모양, 비대와 위축
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Clinical Zone에 의한 soft tissue palpation
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Clinical Zone에 의한 soft tissue palpation
2. 2구역 – 어깨밑주머니
(subacromial bursa)
세모근밑 주머니
(subdeltoid bursa)
http://www.aidmybursa.com/_img/bursitis-drainage-of-subacromial-bursa.jpg
![Page 26: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/26.jpg)
Clinical Zone에 의한 soft tissue palpation
http://what-when-how.com/wp-content/uploads/2012/05/tmpa83a85.png http://www.epainassist.com/images/subacromial-bursitis.jpg
![Page 27: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/27.jpg)
Clinical Zone에 의한 soft tissue palpation
2. 2구역 - 견봉하점액낭(subacromial bursa)
삼각근하 점액낭(subdeltoid bursa)
① 병리적 소견(pathologic finding) ⇒ 견관절 운동을
제한시키거나 심한 압통을 일으킨다.
② palpation ⇒ acromion 바로 밑에서 ;
견봉하 점액낭
③ 수동으로 신전시 ⇒ rotator cuff와 함께 전면으로 회전
④ bursitis 시 ⇒ 심한 압통, palpation 시 조심 要.
![Page 28: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/28.jpg)
Clinical Zone에 의한 soft tissue palpation
3. 3구역 – 겨드랑이(axilla)
Reference: https://home.comcast.net/~wnor/lesson3axilla.htm
![Page 29: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/29.jpg)
Clinical Zone에 의한 soft tissue palpation
3. 3구역 – 겨드랑이(axilla)
Reference: https://home.comcast.net/~wnor/lesson3axilla.htm
![Page 30: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/30.jpg)
Clinical Zone에 의한 soft tissue palpation
3. 3구역 – 겨드랑이(axilla)
① 피라밋 구조⇒ abd 시 손가락을 겨드랑이밑에 놓고
add: 임파선이 있는지 압통이 있는지 측정.
② 액와 전면벽⇒ pectoralis major⇒abd시 앞
후면벽⇒ latissimus dorsi⇒ abd시 뒤
내측벽⇒ serratus anterior
⇒2-6th 늑골
외측벽⇒ 상완이두근구⇒ 외회전 시 대결절과
소결절 사이에서 palpation
③ 위팔신경얼기(brachial plexus)과 겨드랑이 동맥
(brachial artery) ⇒ 겨드랑이 꼭대기 경유
![Page 31: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/31.jpg)
Clinical Zone에 의한 soft tissue palpation
4. 4구역 – 견갑대의 돌출근육
* 근육의 모양, 크기, 긴장력⇒ 양측촉진 * 비정상적 외형, 근육의 소실, 해부학적 구조의 유무⇒ 양측비교
• 압통(tenderness)
![Page 32: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/32.jpg)
Clinical Zone에 의한 soft tissue palpation
4. 4구역 – 견갑대의 돌출근육
Reference: http://en.wikipedia.org/wiki/Sternocleidomastoid_muscle
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Clinical Zone에 의한 soft tissue palpation
2) 큰가슴근(pectoralis major)
http://www.thansworld.com/ONLINEanatomy_1/images/section5/oi_pectoralis.jpg
![Page 34: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/34.jpg)
Clinical Zone에 의한 soft tissue palpation
3) 위팔두갈근(biceps brachii)
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/biceps-brachii/atlasImage
![Page 35: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/35.jpg)
Clinical Zone에 의한 soft tissue palpation
4) 세모근(Deltoid)
http://www.musclesused.com/wp-content/uploads/2012/08/deltoid-Muscle.jpg
![Page 36: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/36.jpg)
Clinical Zone에 의한 soft tissue palpation
5) 등세모근(Trapezius)
http://www.musclesused.com/wp-content/uploads/2012/08/Trapezius-Muscle.jpg
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Clinical Zone에 의한 soft tissue palpation
6) 큰마름근, 작은마름근(Rhomboid major, minor) → scapular add. & downward rot.
http://www.musclesused.com/wp-content/uploads/2012/08/rhomboid11.jpg
![Page 38: Physical examination of the shoulder - KOCWcontents.kocw.net/KOCW/document/2014/gacheon/baeyoungsook/1.pdf① 병리적 소견(pathologic finding) ⇒ 견관절 운동을 제한시키거나](https://reader035.vdocuments.us/reader035/viewer/2022071109/5fe3ef6ec32d304e2514713b/html5/thumbnails/38.jpg)
Clinical Zone에 의한 soft tissue palpation
7) 앞톱니근(serratus anterior) → scapular abd. upward rot.
* Rib1 - Rib7에서 기시 ∼ superior 와 inferior angle
* winging scapular ⇒ 어깨뼈 내연이 고정 안되었을 때.
http://www.shoulderdoc.co.uk/images/uploaded/serratus%20anterior1.jpg