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    Add as Friendassessment of shoulder joint

    by: suvarna

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    1 : Assessment of Shoulder Dr. Suvarna Ganvir Professor
    2 : Learning objectives At the end of the session the learner should be able to 1. describe applied anatomy 2. describe patient history 3.describe observation from Ant , Post view & lateral view 4.describe Active & passive movts 5. describe the palpation procedure.
    3 : Applied Anatomy Glenohumearl joint – ball & socket , synovial type of joint Depends primarily on the musclees & ligamnets When relaxed humerus sits cenetered in the glenoid cavity Rotator cuff ms – plays important role in the stbility & mobility.
    4 : Coracoacromial lig-block to sup translation transverse humeral lig-roof
    5 : Acromioclavicular joint Plane synovial joint Three degrees of freedom Depends on ligamnets Coracoclavicular lig- step deformity
    6 : Sternoclavicular joint Saddle shaped joint 3 degrees of freedom Presence of a adisk Costoclavicular lig-integrity
    7 : Scapulothoracic joint Not a true joint Muscles acting on the scapula Acts as a stable base
    8 : Patient history Age of the patient Mechanism of injury if any Any movts or positions that cause pain Extent & behaviour of the patients pain Activities that cause or increawse the pain Any positions that trelieve the pain Functional impairment
    9 : Feeling of weakness or heaviness after the activity Any indication of the nerve injury
    10 : Observation Suitably undressed Inspect bony & soft tissue contours Observe how does patient manipulate the clothes
    11 : Anterior view Head & neck position , relation with the shoulder Step deformity Swelling present anterior to the AC joint Sulcus deformity on traction the joint Normal round deltoid contour Dominant shoulder is usually lower than the non dominant
    12 : Normal functional position – Scapular plane with 60 0 abduction Arm in neutral or no rotation .
    13 : Posterior view Bony & soft tissue contours & body alignment Position of the scapula Lennie test Snapping scapula Winging of the scapula
    14 : Winging of the scapula Classic Rotary Dynamic Static Reverse origin insertion of the rotator cuff ms Due to spinal accessory nerve palsy Due to long thoracic nerve palsy
    15 : Sprengle’s deformity
    16 : Examination Cervical spine assessment Knowledge of the muscle force & ms balance & kinetic chains is a must for a perfect diagnosis. Comparison of one side of the body with the other
    17 : Active movts Painful movts in the end Force couples Painful arc –active elevation thro abduction – pain is greater when going up & during active abduction painful arc during last 10-20 o abduction –pathology on AC joint or a positive impingement sign
    18 :
    19 : Scapulohumeral rhythm Watch the movt of the scapula in both the ascending & descending phases of the abduction Speed of the abduction Reverse scapulohumeral rhythm
    20 :
    21 : Scaption Elevation in the neutral position Puts less stress on the capsule & surrounding musculature Is the position in which most of the ADL s are performed
    22 : Active lateral rotation –care during applying overpressure-compensation by retraction of the scapula Active medial rotation –hitchhiking – common reference points –greater trochanter , buttocks, waist , spinous process, with T5T10 representing normal degree of medial rotation Crepitus during rotation in 90 o abduction –abrasion sign
    23 : Active extension –swallow tail sign Adduction – horizontal abduction & adduction Scapular retraction & protraction – snapping scapula Apleys Scratch test
    24 : Sustained arm position or repetition if history indicates . Capsular tightness –may have an effect on the active movts Elevation of the humerus in medially rotated position reduces the excursion of the biceps tendon Winging of the scapula – in standing , pushing against the wall ,
    25 : Injury to the various nerves Suprascapular – affect supra& infra spinatus depending on the site Musculocutaneous – Axillary – Radial -
    26 : Passive movts To determine the end feel, any restrictions & presence of a capsular pattern Capsular tightness vs muscular Should be measured – posterior anteroir , Subcoracoid & subacromial bursitis Rowe sign- restricted lateral rotation & supination in forward flexion Passive elevation therough scaption or abduction rotation of the humerus in the quadrant position
    27 : Quadrant position: examiner stabilise the scapula & clavicle –elevation of the UL –adduction –a point where the arm moves forward instead of adduction –indicates the position at which the arm has moved medially during its descent to the patients side. Locked Quadrant position –abduction with medial rotation in extension – a position where the shoulder no longer abducts .
    28 : Resisted isometric movts Supine position –scapula can not be observed Muscles should be tested in more than one position Position the shoulder in adduction with elbow flexed to 90 0 RIT of Elbow should also be done. Differences in relative strengths of various ms
    29 : Functional assessment Act as a part of open kinetic & closed kinetic chain. May be based on ADLs work or recreation or on numerical scoring charts which are derived from clinical as well as functional measures .

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