Examinationof the Shoulder Joint by Dr. Fiifi Brakatu .pptx

Orthopaedic examination of the shoulder

1. Examination of the Shoulder Joint Dr. Fiifi Brakatu

2. Outline Look Feel Move: Range of Motion(Active and Passive) S trength testing S pecial Tests

3. Normal Glenohumeral Range of Motion Parameter Normal Values (Deg) Forward Elevation 170 Abduction 90 External Rotation (Arm Adducted) 70 External Rotation (in Abduction) 100 Internal Rotation (Behind Back) T7 Internal Rotation (in Abduction) 70 Horizontal Adduction 50

4. Strength Tests Grade Findings 5 Normal 4 Weakness against resistance 3 Able to overcome gravity 2 Able to move with gravity eliminated 1 Flicker of movement No muscle activation

5. Empty Can (Jobe)

6. Infraspinatus Strength Test

7. Bear-Hug Test Diagnoses tear in upper border of subscapularis

8. Neer Impingement Sign For diagnosing subacromial impingement syndrome

9. Hawkins-Kennedy Sign Indicates subacromial impingement syndrome or rotator cuff pathology greater tuberosity pressed against the coracoacromial ligament and the acromion

10. Cross-arm test for degenerative pathology of the acromioclavicular joint

11. O’Brien Test also called the active compression test Pain in the glenohumeral joint that is absent if the test is repeated with the shoulder in maximum external rotation (forearm supinated) indicates a SLAP tear

12. Crank Test – SLAP Tear Indicates a SLAP tear The glenohumeral joint is axially loaded in this position along the axis of the humerus, with passive internal and external rotation of the humerus. Pain, particularly in external rotation of the humerus and with a catching sensation, indicates a SLAP tear

13. Speed Test - LHB A downward force is applied to the forearm pain in the anterior shoulder indicates pathology of the LHB tendon

14. Yergason Test - LHB Pain in the bicipital groove with resisted supination (typically with a handshake-type clasp) is a positive test result for pathology of the LHB tendon

15. Glenohumeral Joint Instability

16. Modified Load and Shift Test for anterior and posterior instability of the shoulder A compressive force is applied along the axis of the humerus to center the humeral head in the glenoid cavity. A posterior force can then be applied to assess the degree of translation of the humeral head

17. Grading of Translation With the Load-and-Shift Maneuver Grade Findings Little or no translation (<25% of humeral head diameter) 1 Humeral head moves onto glenoid rim 2 Humeral head can be dislocated but spontaneously reduces 3 Humeral head does not relocate if pressure is removed

18. Sulcus Sign Inferior traction (white arrow) is applied to the adducted arm in neutral and external rotation (external rotation shown). The acromion (black arrow) is evaluated for dimpling Dimpling is noted inferior to the acromion (black arrow) if axial traction (white arrow) is applied to the shoulder

19. Anterior Instability Isolated anterior instability can be diagnosed on physical examination via the anterior apprehension test, relocation test, and surprise test It is a continuum of examination manoeuvres

20. Anterior Apprehension Test

21. Relocation Test

22. Surprise Test The surprise test is performed by releasing the posterior directed force unbeknownst to the patient. A return of the sensation of instability indicates a positive surprise test

23. Posterior Jerk Test – Posterior Instability

24. Gagey H yperabduction T est - Inferior Instability:  the patient’s arm is brought into 90° of abduction. With the scapula stabilized by the examiner, the patient’s shoulder is maximally passively abducted. Hyperabduction greater than 20° of that of the contralateral side or a sensation of instability with this maneuver are considered a positive test.

25. Neurovascular Exam

26. Other Tests

27. That’s a wrap!