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In the name of GOD. Sheikhlotfolah mosque Isfahan. Shoulder &Upper arm Physical Examination. Babak Vahdatpour MD Assi stant professor Department of Physical Medicine & Rehab. Isfahan University of Medical Sciences . DDx. of Shoulder Pain or reduced R.O.M. Rotator Cuff Dis.

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slide1

In the name of GOD

Sheikhlotfolah mosque

Isfahan

shoulder upper arm physical examination
Shoulder &Upper arm Physical Examination

BabakVahdatpour MD

Assistant professor

Department of Physical Medicine & Rehab.

Isfahan University of Medical Sciences

ddx of shoulder pain or reduced r o m
DDx. of Shoulder Pain or reduced R.O.M
  • Rotator Cuff Dis.
  • Adhesive Capsulitis
  • Calcific Tendonitis
  • Dynamic Functional Instability
  • A.C Degenerative Joint Dis.
  • Glenohumeral Degenerative Joint Dis.
  • Arthropathy(crystalline & Rheumatoid)
  • Cervical Radiculopathy
  • Tumors(shoulder girdle & lung apex)
physical examination
Physical Examination
  • inspection
  • palpation
  • range of motion
  • strength
  • provocative shoulder test
  • neck & elbow
inspection
Inspection
  • both shoulders exposed
  • inspection of both shoulders
  • swelling
  • asymmetry
  • muscle atrophy
  • scars
  • ecchymosis
  • venous distension
inspection1
Inspection
  • squaring of the shoulder→ anterior dislocation

Swollen subacromial bursa in R.A Rupture of the left pectoralis major tendon.

inspection2
Inspection

Fractured left clavicle. Swollen sternoclavicular joint due to a fracture of the medial end of the left clavicle

slide13
scapular "winging"→ shoulder instability serratus anterior dysfunction trapezius dysfunction
  • Rupture of the long head

of the biceps tendon (arrow).

inspection3
Inspection
  • atrophy of the supraspinatus or infraspinatus→ rotator cuff tear suprascapular nerve entrapment neuropathy
palpation
Palpation
  • tenderness
  • deformity
slide16

1.subacromial space → rotator cuff tendinitis impingement syndrome calcific tendinitis rotator cuff tear2.bicipital groove → bicipital tendinitis bicipital tendon subluxation, tear

3.acromioclavicular joint

4.anterior glenohumeral joint → glenohumoral arthritis osteonecrosis glenoid labrum tear

adhesive capsulitis 5.sternoclavicular joint

slide17

6.posterior edge of acromion → rotator cuff tendinitis calcific tendinitis rotator cuff tear

7.suprascapular notch → suprascapular nerve entrapment

8.Quadrilateral space → axillary nerve entrapment

range of motion testing
Range of Motion testing
  • compared with the unaffected side
  • active & passive: loss of active motion alone → weakness of muscle than joint ds: LOM with both active & passive Ex → arthropathies adhesive capsulitis
range of motion testing1
Range of Motion testing
  • Flextion & Extension
  • Abduction & Adduction (scapulohumeral rhythm)
  • Internal rotation & External rotation
  • Scapular Retraction & Protraction
slide24
Painful arc of abduction. Passive shoulder abduction
slide25
Shrugging of the scapula to increase abduction (right shoulder)
slide27
Measurement of rotation in 90° abduction. A, Neutral position. B, External rotation.

C, Internal rotation.

muscle testing
Muscle testing
  • Scapular stabilizers
  • Rotator cuff
  • Humeral Adductor/Internal Rotators
  • Humeral Abductors
  • Elbow Flexors & Extensors
scapular stabilizers
Scapular stabilizers
  • Serratus ant.
  • Rhomboids
  • Trapezius
evaluating the rotator cuff
Evaluating the Rotator cuff
  • supraspinatusinfraspinatusteres minorsubscapularis
  • pain
  • weakness
supraspinatus
Supraspinatus
  • "empty can" test (Jobe test)

FIGURE 3. Supraspinatus examination ("empty can" test). The patient attempts to elevate the arms against resistance while the elbows are extended, the arms are abducted and the thumbs are pointing downward.

infraspinatus and teres minor
Infraspinatus and Teres minor

FIGURE 4. Infraspinatus/teres minor examination. The patient attempts to externally rotate the arms against resistance while the arms are at the sides and the elbows are flexed to 90 degrees

humeral adductor internal rotators
Humeral Adductor/Internal Rotators
  • Pecturalis Major
  • Latissimus Dorsi
humeral abductors
Humeral Abductors
  • Deltoid
  • Supraspinatous
elbow flexors extensors
Elbow Flexors & Extensors
  • Biceps
  • Brachialis
  • Brachioradialis
  • Triceps
neer s test sign
Neer'stest(sign)
  • subacromialimpingement
  • impingement test: injection

FIGURE 5. Neer's test for impingement of the rotator cuff tendons under the coracoacromial arch. The arm is fully pronated and placed in forced flexion.

hawkin s test
Hawkin's test
  • subacromialimpingement
  • rotator cufftendonitis

FIGURE 6. Hawkins' test for subacromial impingement or rotator cuff tendonitis. The arm is forward elevated to 90 degrees, then forcibly internally rotated.

drop arm test
Drop-arm test
  • rotator cuff tear
  • supraspinatus dysfunction
o brien test
O`Brien test

A.C joint or labrum injury

cross chest test
Cross-chest test
  • acromioclavicularjoint dysfunction

FIGURE 7. Cross-arm test for acromioclavicular joint disorder. The patient elevates the affected arm to 90 degrees, then actively adducts it.

ant apprehension
Ant. Apprehension
  • ant. instability

FIGURE 8. Apprehension test for anterior instability. The patient's arm is abducted to 90 degrees while the examiner externally rotates the arm and applies anterior pressure to the humerus.

sulcus sign
Sulcus sign
  • inferior glenohumeralinstability

FIGURE 10. Sulcus test for glenohumeral instability. Downward traction is applied to the humerus, and the examiner watches for a depression lateral or inferior to the acromion.

speed s maneuver
Speed's maneuver
  • proximal tendon of the long head of the biceps
yergason test
Yergason test
  • biceps tendon

FIGURE 9. Yergason test for biceps tendon instability or tendonitis. The patient's elbow is flexed to 90 degrees, and the examiner resists the patient's active attempts to supinate the arm and flex the elbow.

slide53

33 pole

Isfahan