examinarea umarului

8/13/2019 examinarea umarului

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SHOULDER

EXAMINATION


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the scapula is offset 30 degrees from the

frontal plane -- this is called the scapular

plane


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Glenohumeral joint

Capsu lar l igaments:joins theglenohumeral joint capsule

anteriorly, inferiorly, andposteriorly

Coracohumeral l igament:provides stability superiorly,preventing superior translation


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Rotator Cuff

Supraspinatus:abducts thehumeral head and acts as a humeralhead depressor

Infrasp inatus:externally rotates

and horizontally extends thehumerus

Subs capular is:internally rotatesthe humerus

Teres m inor: externally rotates andextends the humerus


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Subscapularis


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Conditions

Tumors/swellings

Nonunions

Instability

Subacromial impingement

Rotator cuff rupture SLAP Lesions


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History

Pain/instabilty/both

Decreased ROM

Dominant hand

Occupation

Trauma Childhood history


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General examination

Prominent veins

Neck viens/swellings

Chest movements

Fingerstrophic changes

General condition

CHEST EXAMINATION


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Shoulder examination

LOOK

TOUCH

MOVE

MEASURE


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Inspection

Attitude

Front

Side

Back


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Inspection

Front

Chest wall

Pect majorClavicle/recess

AC joint alignment

Deltoid contour

Any other swellings


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Side

Deltoid

AC jointWasting of cuff muscles

Swellings head of humerus

Scapula

Ant chest wall


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Back

Swellings

Muscles = wasting

Scapula alignment

AC joint

Deltoid Interscapualar region


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Palpation

Temperature

Tenderness

Swellings

Bony points Clavicle

Acromion

Humeral head

Coracoid AC joint

Scapula


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Movements

Flexion

Extension

Internal rotation

External rotation


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abduction


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Measurements

Arm length

Arm span:height


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Special tests


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Apley

scratch testPatient touches superior and inferior

aspects of opposite scapula

Loss of range of motion:

rotator cuff problem

Neer's sign Arm in full flexion Subacromial impingement

Hawkins'

testForward flexion of the shoulder to 90

degrees and internal rotation

Supraspinatus tendon

impingement

Drop-armtest

Arm lowered slowly to waist Rotator cuff tear

Cross-arm

testForward elevation to 90 degrees and active

adduction

Acromioclavicular joint

arthritis

Spurling'stest

Spine extended with head rotated toaffected shoulder while axially loaded

Cervical nerve rootdisorder

Apprehensi

on testAnterior pressure on the humerus with

external rotation

Anterior glenohumeral

instability


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Relocation

test

Posterior force on humerus while externally

rotating the arm

Anterior glenohumeral

instability

Sulcus sign Pulling downward on elbow or wrist Inferior glenohumeral

instability

Yergason test Elbow flexed to 90 degrees with forearm

pronated

Biceps tendon instability or

tendonitis

Speed's

maneuver

Elbow flexed 20 to 30 degrees and forearm

supinated

Biceps tendon instability or

tendonitis

"Clunk" sign Rotation of loaded shoulder from extension

to forward flexion

Labral disorder


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Special Tests - Instability

Sulcus sign


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Special TestsInstabilityGerber-Ganz Anterior Drawer Test &

Jerk test


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Special Tests - Instability

Anterior apprehension sign


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Special Tests - Impingement

Neers sign

Hawkins sign

Jobes sign


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Neers sign



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Hawkins test


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Jobes test


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Special Tests - Rotator Cuff

External rotation lag sign (ERLS)

Hornblowers sign

Infraspinatus / teres minor

Internal rotation lag sign (IRLS)

Liftoff test

Subscapularis

Zaslavs internal impingement test


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External rotation lag sign (ERLS)

Infraspinatus / teres minor


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Internal rotation lag sign (IRLS)

Liftoff test Subscapularis


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Belly Press test


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Zaslavs internal impingement test


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Special Tests - Biceps

Speeds test

Yergasons test


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Speeds test


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Yergasons tests


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Special TestsSLAP Lesions

OBriens Test

Compression / rotation test

Pain Provocation test


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OBriens Test


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Compression / rotation test


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Crank test


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Kiblers anterior slide test


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Ac jointcross arm test

Point tenderness over AC joint


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Scarf test


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Finally

Neurological examination

Hand functions

Pulses

Other shoulder

Same elbow

SPINE

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