Understanding Shoulder Anatomy and Common Disorders

 
THE SHOULDER
 
IN THE  URGENT CARE CLINIC
GREGORY JONES MD
 
Actually four joints
 
The shoulder consists of three joints:
 GLENOHUMERAL
 
Sternoclavicular join
Acromioclavicular joint
Scapulothoracic joint
 
MUSCLES
 
SUPRASPINATUS
:  Abduction
INFRASPINATUS
: External rotation and 
adduction
TERES MINOR
: External rotation and 
adduction
SUBSCAPULARIS
: Internal rotation and 
adduction
 
 
 
ROTATOROCUFF
ANATOMY
POSTERIOR VIEW
 
ROTATOR CUFF
ANATOMY
ANTERIOR
VIEW
 
LIGAMENTS
AND CAPSULE
GLENOHUMERAL
JOINT
 
A CUP WITH MOBILE SIDE
WALLS. ALLOWS FOR
MOBILITY OF JOINT AND
STRENGHT. SUBJECT TO
INJURY.
 
SHOULDER PAIN DIFFERENTIAL
 
INFECTION-UNUSUAL
ROTATOR CUFF IMPINGEMENT
TENDONITIS,TENDON TEAR ("POPEYE MUSCLE")
LABRUM TEAR (SLAP)
FROZEN SHOULDER-ADHESIVE CAPSULITIS
BURSITS-SUB ACROMION
DISLOCATION -IS THIS THE FIRST TIME? ACUTE-PAIN,DECR ROM, XRAY
CERVICAL RADICULAPATHY: SPURLING'S SIGN/TEST
 
 
HISTORY
 
 
ACUTE OR CHRONIC
AGE 
35-75: ROTATOR CUFF DISORDERS MOST COMMON
PAIN WITH OVERHEAD REACHING, OCCUPATIONAL, REPETITIVE
MOTIONS, PAIN WITH SLEEP
ATHLETES
WEAKNESS IS IT FROM PAIN OR TRUE WEAKNESS
 
 
EXAMINATION
 
LOOK FOR SCARS
ATROPHY- (INFRASPINATUS,SUPRASPINATUS, DELTOID)
SCAPULAR WINGING
NEURO-MOTOR
VASCULAR
DIFFERENTIAL: CONSIDER CERVICAL RADICULOPATHY, PRIPHERAL NEUROPATHY
ERYTHEMA
HEAT
 
 
 
 
 
 
 
 
 
 
 
PALPATION
 
SC JOINT
AC JOINT
ACROMION
CORACOID PROCESS
BICIPITAL GROOVE
LESSER AND GREATER TUBERCLE
SCAPULA
 
ROM SIX PLANES + ONE
 
FORWARD ELEVATION 150-180 DEGREES
EXTERNAL ROTATION 9O DEGREES ABDUCTION
EXTERNA ROTATION AT SIDE
ABDUCTION
INTERNAL ROTATION (T4-T8)
INTERNAL  ROTATION ABDUCTION
SCAPULA PLANE
 
                       APLEY SCRATCH TEST
 
S
H
O
U
L
D
E
R
 
T
E
S
T
S
 
SHOULDER IMPINGEMENT SYNDROME :TIGHT - CAN LEAD TO
BURSITIS, TENDONITIS AND EVENTUALLY TEARS
DROP ARM TEST FOR 
SUPRASPINATUS
NEER TEST- TEST FOR 
SUB ACROMIAL
 IMPINGEMENT
HAWKINS TEST- FORWARD FLEXION INTERNAL ROTATION "TRAFFIC
COP" SIGN-TEST FOR 
SUPRASPINATUS
"EMPTY CAN TEST" (JOBE TEST) -
SUPRASPINATUS
 POSSIBLY MORE
SPEED'S AND YEGERSON'S-
BICIPTAL 
GROOVE
OBRIAN'S-AC JOINT AND 
GLENOID LABRUM
 
ROTATOR CUFF MUSCLES (SITS)
 
SYMPTOM'S: POSTERIOR SHOULDER PAIN,WEAKNESS, NIGHT PAIN
 
S
UPRASPINATUS-
EMPTY CAN SIGN
 (JOBE), NEER TEST ,
HAWKINS  AND 
DROP ARM TEST
I
NFRASPINATUS –EXTERNAL ROTATOR
T
ERES MINOR- EXTERNAL ROTATORS-
S
UBSCAPULARIS- INTERNAL
ROTATION- 
LIFT OFF
BELLY PRESS
 TESTS
 
 
 
 
BICEPS
 
BICIPITAL GROOVE PAIN
SPEED'S TEST: FORWARD ELEVAT SHOLDER AGAINST RESISTANCE
METHOD
:WITH ELBOW EXTENDED AND FOREARM SUPINATED.
POSITIVE WHEN THERE IS PAIN IN BISIPITAL GROOVE
YERGASON'S SIGN: POSITIVE WHEN THERE IS PAIN IN BICIPITAL
GROOVE. 
METHOD:
 ELBOW AT 90 DEGREES, FOREARM PRONATED.
PATIENT ATTEMPTS TO ACTIVELY SUPINATE FOREARM AGAINST
RESISTANCE.
"POPEYE" SIGN: C/W WITH TEAR OF LONGHEAD OF BICEPS
 
AC JOINT
 
LOCAL TENDERNESS
CROSS-BODY ADDUCTION
OBRIEN'S TEST THIS TEST FOR SLAP TEARS BUT MAY BE POSITIVE
WITH AC PROBLEMS
 
INSTABILITY
 
VARIOUS TEST  FOR SHOULDER DISLOCATION AND RELCATION
SULCUS SIGN
 
GLENOHUMERAL
INSTABILITY TEST
 
APPREHENSION TEST
 
SHOULDER
INSTABILITY
 
A: APPREHENSION
B: RELOCATION
 
EXCELLENT REFERENCES
 
https://www.aafp.org/afp/2008/0215/p453.html
 
https://www.aafp.org/afp/2008/0215/p493.html
 
https://www.aafp.org/afp/2016/0715/p119.html
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The shoulder is a complex joint consisting of multiple components like joints, muscles, ligaments, and capsules. Understanding its anatomy is crucial for diagnosing common disorders such as rotator cuff issues, tendinitis, tears, and frozen shoulder. History, examination, and palpation techniques are essential for assessing shoulder conditions, with a focus on identifying potential causes of pain and weakness. Images and descriptions provide insight into shoulder structure and functioning, aiding in differentiating between various shoulder conditions.


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  1. THE SHOULDER IN THE URGENT CARE CLINIC GREGORY JONES MD

  2. Actually four joints The shoulder consists of three joints: GLENOHUMERAL Sternoclavicular join Acromioclavicular joint Scapulothoracic joint

  3. MUSCLES SUPRASPINATUS: Abduction INFRASPINATUS: External rotation and adduction TERES MINOR: External rotation and adduction SUBSCAPULARIS: Internal rotation and adduction

  4. ROTATOROCUFF ANATOMY POSTERIOR VIEW

  5. ROTATOR CUFF ANATOMY ANTERIOR VIEW

  6. LIGAMENTS AND CAPSULE

  7. GLENOHUMERAL JOINT A CUP WITH MOBILE SIDE WALLS. ALLOWS FOR MOBILITY OF JOINT AND STRENGHT. SUBJECT TO INJURY.

  8. SHOULDER PAIN DIFFERENTIAL INFECTION-UNUSUAL ROTATOR CUFF IMPINGEMENT TENDONITIS,TENDON TEAR ("POPEYE MUSCLE") LABRUM TEAR (SLAP) FROZEN SHOULDER-ADHESIVE CAPSULITIS BURSITS-SUB ACROMION DISLOCATION -IS THIS THE FIRST TIME? ACUTE-PAIN,DECR ROM, XRAY CERVICAL RADICULAPATHY: SPURLING'S SIGN/TEST

  9. HISTORY ACUTE OR CHRONIC AGE 35-75: ROTATOR CUFF DISORDERS MOST COMMON PAIN WITH OVERHEAD REACHING, OCCUPATIONAL, REPETITIVE MOTIONS, PAIN WITH SLEEP ATHLETES WEAKNESS IS IT FROM PAIN OR TRUE WEAKNESS

  10. EXAMINATION LOOK FOR SCARS ATROPHY- (INFRASPINATUS,SUPRASPINATUS, DELTOID) SCAPULAR WINGING NEURO-MOTOR VASCULAR DIFFERENTIAL: CONSIDER CERVICAL RADICULOPATHY, PRIPHERAL NEUROPATHY ERYTHEMA HEAT

  11. PALPATION SC JOINT AC JOINT ACROMION CORACOID PROCESS BICIPITAL GROOVE LESSER AND GREATER TUBERCLE SCAPULA

  12. ROM SIX PLANES + ONE FORWARD ELEVATION 150-180 DEGREES EXTERNAL ROTATION 9O DEGREES ABDUCTION EXTERNA ROTATION AT SIDE ABDUCTION INTERNAL ROTATION (T4-T8) INTERNAL ROTATION ABDUCTION SCAPULA PLANE

  13. APLEY SCRATCH TEST

  14. SHOULDER TESTS SHOULDER TESTS SHOULDER IMPINGEMENT SYNDROME :TIGHT - CAN LEAD TO BURSITIS, TENDONITIS AND EVENTUALLY TEARS DROP ARM TEST FOR SUPRASPINATUS NEER TEST- TEST FOR SUB ACROMIAL IMPINGEMENT HAWKINS TEST- FORWARD FLEXION INTERNAL ROTATION "TRAFFIC COP" SIGN-TEST FOR SUPRASPINATUS "EMPTY CAN TEST" (JOBE TEST) -SUPRASPINATUS POSSIBLY MORE SPEED'S AND YEGERSON'S-BICIPTAL GROOVE OBRIAN'S-AC JOINT AND GLENOID LABRUM

  15. ROTATOR CUFF MUSCLES (SITS) SYMPTOM'S: POSTERIOR SHOULDER PAIN,WEAKNESS, NIGHT PAIN SUPRASPINATUS-EMPTY CAN SIGN (JOBE), NEER TEST , HAWKINS AND DROP ARM TEST INFRASPINATUS EXTERNAL ROTATOR TERES MINOR- EXTERNAL ROTATORS-SUBSCAPULARIS- INTERNAL ROTATION- LIFT OFF, BELLY PRESS TESTS

  16. BICEPS BICIPITAL GROOVE PAIN SPEED'S TEST: FORWARD ELEVAT SHOLDER AGAINST RESISTANCE METHOD:WITH ELBOW EXTENDED AND FOREARM SUPINATED. POSITIVE WHEN THERE IS PAIN IN BISIPITAL GROOVE YERGASON'S SIGN: POSITIVE WHEN THERE IS PAIN IN BICIPITAL GROOVE. METHOD: ELBOW AT 90 DEGREES, FOREARM PRONATED. PATIENT ATTEMPTS TO ACTIVELY SUPINATE FOREARM AGAINST RESISTANCE. "POPEYE" SIGN: C/W WITH TEAR OF LONGHEAD OF BICEPS

  17. AC JOINT LOCAL TENDERNESS CROSS-BODY ADDUCTION OBRIEN'S TEST THIS TEST FOR SLAP TEARS BUT MAY BE POSITIVE WITH AC PROBLEMS

  18. INSTABILITY VARIOUS TEST FOR SHOULDER DISLOCATION AND RELCATION SULCUS SIGN

  19. GLENOHUMERAL INSTABILITY TEST APPREHENSION TEST

  20. SHOULDER INSTABILITY A: APPREHENSION B: RELOCATION

  21. EXCELLENT REFERENCES https://www.aafp.org/afp/2008/0215/p453.html https://www.aafp.org/afp/2008/0215/p493.html https://www.aafp.org/afp/2016/0715/p119.html

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