Orthopaedics

OrthopaedicsShoulder ExaminationShoulder ExaminationInspectionPalpationRange of motionActive and passiveNeurovascular Exam

InspectionSkinScarsSymmetrySwellingAtrophyHypertrophyScapular wingingPalpationAll bony prominences around shoulder girdle (AC joint)Muscles and soft tissues includingdeltoidrotator cuff musclestrapeziusbiceps tendon in grooveRange of MotionCompare active and passive motion, both sidesSeven planes of motion should be examined and documentedforward elevation (150-180 considered normal)external rotation atsideAbductioninternal rotation to vertebral height (T4-T8 considered normal)internal rotationat 90 degrees abductionNeurovascular ExamSensationcheck dermatomes of following nervesaxillarymusculocutaneousmedial Brachial/Antebrachial CutaneousmedianradialulnarMotorDeltoid, Biceps, Triceps, Extensor Pollicis Longus, Flexor Digitorum Profundus, Dorsal InterosseiVascularbrachial, radial, ulnar artery pulsesSpecial TestsNeer Impingement Signindicative ofimpingementas well as many other causes of shoulder pain/focal abnormalities (stiffness, OA, instability, bone lesions); note you must have full range of motion for "positive" finding.techniqueuse one hand to prevent motion of the scapula while raising the arm of the patient with the other hand in forced elevation (somewhere between flexion and abduction) eliciting pain (positive test) as the greater tuberosity impinges against the acromion (between 70-110)Special TestsHawkins Signpositive withimpingementtechniqueperformed by flexing shoulder to 90, flex elbow to 90, and forcibly internally rotate driving the greater tuberosity farther under the CA ligament. test for impingement.

Special TestsJobes Testtests for supraspinatus weakness and/or impingementtechniqueabduct arm to 90, angle forward 30 (bringing it into the scapular plane), and internally rotate (thumb pointing to floor). Then press down on arm while patient attempts to maintain position testing for weakness or pain.Special TestsApprehension and Relocationpositive test if the patient experiences the sensation of instabilitytechniquehave the patient lie supine.Apprehension test performed by bringingthe arm in 90 degrees of abduction and full external rotation and patient experiences sense of instability. Relocation test performed by placing examiner's hand on humeral head applying a posterior force on the humeral head. Patient will experience reduction or elimination of sense of instability.Questions?