Understanding Shoulder Anatomy and Common Disorders
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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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
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
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
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
