physical examination of the shouldercme.uthscsa.edu/presentations/sports13/011913/1_physical exam...
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PHYSICAL EXAMINATION
OF THE SHOULDER
Philip M. Jacobs, M.D.
Clinical Associate ProfessorOrthopaedics UTHSCSA
The San Antonio Orthopaedic Group
Financial Disclosure
Dr. Philip M. Jacobs has no relevant financial relationships with commercial interests to disclose.
This presentation is the intellectual property of the author. Contact them at [email protected] forpermission to reprint and/or distribute.
PRICELESS
2012
Ouch 2012
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Bull Wins 2012
Bad Day on Golf Course 2012
Tough Day in Gym2012
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PHYSICAL EXAMINATION
OF THE SHOULDER
Clinical Evaluation
Sport Intensity of participationOffending activityArm position during activity
TRAUMATIC
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ATRAUMATIC
EVALUATION OF PAINFUL SHOULDER
History - TraumaticDefine mechanism of injuryPosition of armAmount of force appliedPoint of force
EVALUATION OF PAINFULSHOULDER
History - AtraumaticLength of symptomsWhat aggravates the pain?What relieves the pain?
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Clinical Evaluation
Pain– Associated with activity– During/After (not disabling)– During/After (disabling)– Activities of daily living
Differential Diagnosis of Shoulder Problems in Athletes
Rotator Cuff or Biceps Tendon– Strain, Tendinitis, Tear
Glenohumeral instabilityGlenohumeral instability with secondary impingementPrimary impingement of the cuff or biceps tendonCalcific TendinitisAcromioclavicular joint pathologyGlenohumeral arthritisCervical spine pathologyThoracic outlet syndromeAdhesive capsulitisSuprascapulararthropathyAngina, lung tumor, gallbladder disease
Physical ExamInspectionPalpationROMMuscle TestingStability TestingSpecial TestsNeurovascular Exam
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Physical Exam
Inspection – Symmetry, AtrophyPalpation– Location/Degree tenderness– Biceps/Bicipital Groove– SupraspinatusInsertion– AC Joint
Physical Exam
ROM – FF, ER, IR– Note discrepancies in AROM vs.
PROM
Physical Exam
Muscle Testing - Rotator Cuff– Supraspinatus – Resistance with
AB 90, FF 30, pronated– Infraspinatus/TM – Resisted ER– Subscapularis – Lift off
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ROTATOR CUFF
SUBSCAPULARIS TESTING
ER LAG TEST
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ER LAG TEST
STABILITY TESTING
Load / Shift TestSulcus SignApprehension / Relocation Test
Load and Shift
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Load and Shift
Sulcus Sign
Apprehension / Relocation
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Special Tests
Impingement– Painful arc of abduction 60-120
degrees– Pain on forced forward flexion– Pain on forcible internal rotation
with 90 degrees forward flexion
Impingement
Special Tests
Cross Arm Adduction – AC JointO’Brien’s TestLabral Entrapment Test MDI / Ligamentous Laxity
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O’Brien’s Test
O’Brien’s Test
Labral Entrapment Test
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MDI / Ligamentous Laxity
Neurovascular Exam
Neuro Exam ( Motor / Sensory)- Distal Exam- Axillary Nerve
Motor – DeltoidSensory – Lateral aspect of
shoulder
Neurovascular Exam
Vascular ExamDistal Pulses – Radial and Ulnar
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