CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES...
Transcript of CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES...
![Page 1: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/1.jpg)
CLINICAL ASSESSEMENT OF
THE SHOULDER GIRDLE
Remy Flückiger, MD
Shoulder, Elbow & Orthopedic Sports Medicine
Department of Orthopedic Surgery and Traumatology
University of Berne, Switzerland
![Page 2: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/2.jpg)
• Personal history
• Clinical exam
• Complementary investigations to rule out differential diagnosis
INTRODUCTION
SUSPECTED DIAGNOSIS
![Page 3: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/3.jpg)
Reasons for consultation:
— Pain +++
— Instability +++
— Loss of function
(Pseudoparalysis versus Stiffness)
In sport traumatology
ANAMNESIS
![Page 4: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/4.jpg)
Pain characteristics:Intensity: VAS (/10)
Location (one FINGER +++):
Irradiation:
Into the arm, hand, neck
Night pain?
Relieving/exacerbating factors?
Motion? Sport’s level and discipline?
ANAMNESIS
![Page 5: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/5.jpg)
INTEGUMENT
INSPECTION
BONES
MUSCLES
PALPATION
SC-jointAC-joint
Bicipital groove
LAXITY/INSTABILITY
FUNCTION
IMPINGEMENT /AC JOINT
MUSCLES
PAINFUL ARC 60-120°NEER
HAWKINS
PAINFUL ARC >120°PALPATION PAIN
BODY CROSS
SSPISP SSC
BICEPS
WEAK ABDJOBE
ER LAG < 15°
WEAK ERPATTE
ER LAG > 15°
INCR. PASSIVE ERLIFT OFF
BELLY PRESS
POPEYEPALPATION+++
PALM UP
SULCUS SIGNAR > 85°
HYPERABDUKTION
ANT. APPREHENSIONPOST. APPREHENSION
JOBE RELOCATION
RULE OF „3“
![Page 6: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/6.jpg)
BONES
Deformation of bony landmarks
! Distal clavicle +++
! Acromion
Acromio-clavicular Lesion Rx
INSPECTION
![Page 7: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/7.jpg)
Trapezoid & conoid ligament
= suspensory ligaments of the shoulder girdle
AC-JOINT DISLOCATION: VERTICAL INSTABILITY
![Page 8: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/8.jpg)
Courtesy of J. de Beer
ROTATORY INSTABILITY OF THE SCAPULA
![Page 9: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/9.jpg)
MUSCLES
Muscular atrophies
Fossa SSP/ISP
Deltoideus
INSPECTION
![Page 10: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/10.jpg)
BICEPS
Popeye Sign
Proximal lesion of the LHB
INSPECTION
![Page 11: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/11.jpg)
NEURAL LESIONS
- N. accessorius
- N. thorac. long.
- N. supraskapul.
- N. axillaris
INSPECTION
![Page 12: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/12.jpg)
- N. accessorius
- N. thorac. long.
- N. supraskapul.
- N. axillaris
NEURAL LESIONS INSPECTION
![Page 13: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/13.jpg)
- N. accessorius
- N. thorac. long.
- N. supraskapul.
- N. axillaris
NEURAL LESIONS INSPECTION
![Page 14: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/14.jpg)
- N. accessorius
- N. thorac. long.
- N. supraskapul.
- N. axillaris
NEURAL LESIONS INSPECTION
![Page 15: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/15.jpg)
- N. accessorius
- N. thorac. long.
- N. supraskapul.
- N. axillaris
NEURAL LESIONS INSPECTION
![Page 16: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/16.jpg)
INTEGUMENT
INSPECTION
BONES
MUSCLES
PALPATION
SC-jointAC-joint
Bicipital groove
LAXITY/INSTABILITY
FUNCTION
IMPINGEMENT /AC JOINT
MUSCLES
PAINFUL ARC 60-120°NEER
HAWKINS
PAINFUL ARC >120°PALPATION PAIN
BODY CROSS
SSPISP SSC
BICEPS
WEAK ABDJOBE
ER LAG < 15°
WEAK ERPATTE
ER LAG > 15°
INCR. PASSIVE ERLIFT OFF
BELLY PRESS
POPEYEPALPATION+++
PALM UP
SULCUS SIGNAR > 85°
HYPERABDUKTION
ANT. APPREHENSIONPOST. APPREHENSION
JOBE RELOCATION
RULE OF „3“
![Page 17: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/17.jpg)
PALPATIONSC-JOINT
![Page 18: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/18.jpg)
BONY LANDMARKS PALPATION
![Page 19: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/19.jpg)
RANG OF MOTION (ROM)
JOINT FUNCTION
• Global versus glenohumeral
• Active versus passive
LAG-Signs: Difference between active and
passive ROM
FUNCTION
![Page 20: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/20.jpg)
Stiffness
active
passive normal passive limited
Damaged Motor
LOSS OF ROM FUNCTION
![Page 21: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/21.jpg)
• Critical for decision making!
• Two elementary clinical situations
passive normal
(Pseudo-)Paralysis
DD: - RCT
- Neural lesion
! active Passive free
LOSS OF ACTIVE ROM
FUNCTION
![Page 22: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/22.jpg)
Passive and active limitation
Stiffness
DD: - Capsulitis (Frozen Shoulder)
- Osteoarthritis
LOSS OF ACTIVE ROM
FUNCTION
• Critical for decision making!
• Two elementary clinical situations
![Page 23: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/23.jpg)
DEFINITIONS
FUNCTIONAL PLAINS:
• Flexion (sagittal plain)
• Elevation (scapular plain)
• Abduction (coronar plain)
• External rotation (ER)
• Internal rotation (IR)
FUNCTION
![Page 24: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/24.jpg)
FLEXION (Anteversion)
Documentation in Degrees
FUNCTION
![Page 25: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/25.jpg)
ELEVATION FUNCTION
Documentation in Degrees
![Page 26: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/26.jpg)
EXTERNAL ROTATION (ER)
FUNCTION
Documentation in Degrees
![Page 27: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/27.jpg)
Documentation in levels
gluteal
Sacrum
LW3
Th10/Th12
Th12
INTERNAL ROTATION (IR)
FUNCTION
![Page 28: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/28.jpg)
Painful arc > 120° abduction
AC-ARTRHOPATHY
![Page 29: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/29.jpg)
„BODY CROSS“ TEST FUNCTION
![Page 30: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/30.jpg)
FUNCTIONNEER IMPINGEMENT SIGN
![Page 31: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/31.jpg)
(5- 10 ml 1% Lidocaine in subacromial space)
FUNCTIONNEER IMPINGEMENT TEST
![Page 32: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/32.jpg)
HAWKINS / KENNEDY FUNCTION
![Page 33: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/33.jpg)
WALCH TEST
Postero-superiorer Impingement
! Impingement of SSP between head and glenoid
ABER
Dorsal pain
No apprehension
FUNCTION
![Page 34: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/34.jpg)
SUPRASPINATUS FUNCTION
- Pain at night and during overhead activities
- Normal motion in 95% with full thickness tear
- Weakness in elevation(Skapular plain)
![Page 35: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/35.jpg)
JOBE TEST
• CAVE: only weakness!
FUNCTION
![Page 36: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/36.jpg)
WHIPPLE TEST FUNCTION
![Page 37: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/37.jpg)
ER-LAG < 15° FUNCTION
![Page 38: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/38.jpg)
ER FORCE
Arm in adduction
FUNCTION
![Page 39: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/39.jpg)
PATTE TEST FUNCTION
![Page 40: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/40.jpg)
ER-LAG > 15° FUNCTION
![Page 41: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/41.jpg)
Increased passive ER
!!!!"##$"%$&'()*+"*$,*&-)!
SUBSCAPULARIS FUNCTION
![Page 42: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/42.jpg)
LOSS OF ACTIVE IR
Lift off Test and IR-Lag
FUNCTION
![Page 43: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/43.jpg)
LOSS OF PASSIVE IR
Belly press Test
FUNCTION
![Page 44: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/44.jpg)
FUNCTIONPALM UP TEST
![Page 45: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/45.jpg)
O‘BRIEN TEST FUNCTION
![Page 46: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/46.jpg)
SULCUS SIGN FUNCTION
![Page 47: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/47.jpg)
GENERALIZED HYPERLAXITY
FUNCTION
![Page 48: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/48.jpg)
ANTERIOR HYPERLAXIZITY
!"#$$%&'!()!*!+,-!
FUNCTION
![Page 49: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/49.jpg)
HYPERABDUCTION
Side to side difference more than 20°
„Lachman“ of the shoulder
FUNCTION
Inferior Shoulder hyperlaxity :
Side to side difference in hyperabduction >20° (Gagey Test)
![Page 50: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/50.jpg)
FUNCTIONANTERIOR APPREHENSION
![Page 51: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/51.jpg)
Apprehension and/or pain
Apprehension and/or pain "
FUNCTIONRELOCATION
![Page 52: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/52.jpg)
FUNCTIONRELOCATION
![Page 53: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/53.jpg)
FUNCTIONPOSTERIOR APPREHENSION
![Page 54: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/54.jpg)
TAKE HOME MESSAGES
• Detailed clinical analysis
• Diagnosis after clinical assessment
• Complementary investigations (Rx, MRI, CT) to confirm suspected diagnosis
![Page 55: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/55.jpg)
• always bilateral exam (look for asymmetries)
• Active versus passive limitation of ROM
• LAG = Difference between active and passive ROM
• Normal ROM possible with torn SSP
• Laxity ≠ Instability
TAKE HOME MESSAGES
![Page 56: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/56.jpg)
Remy Flückiger, MD
Shoulder, Elbow & Orthopedic Sports Medicine
Department of Orthopedic Surgery and Traumatology
University of Berne, Switzerland
THANK YOU !
![Page 57: CLINICAL ASSESSEMENT OF THE SHOULDER GIRDLE · ANAMNESIS. INTEGUMENT INSPECTION BONES MUSCLES PALPATION SC-joint AC-joint Bicipital groove LAXITY/INSTABILITY FUNCTION ... - Osteoarthritis](https://reader031.fdocuments.in/reader031/viewer/2022022117/5c9d530988c993a1348ca43a/html5/thumbnails/57.jpg)
INTEGUMENT
INSPECTION
BONES
MUSCLES
PALPATION
SC-jointAC-joint
Bicipital groove
LAXITY/INSTABILITY
FUNCTION
IMPINGEMENT /AC JOINT
MUSCLES
PAINFUL ARC 60-120°NEER
HAWKINS
PAINFUL ARC >120°PALPATION PAIN
BODY CROSS
SSPISP SSC
BICEPS
WEAK ABDJOBE
ER LAG < 15°
WEAK ERPATTE
ER LAG > 15°
INCR. PASSIVE ERLIFT OFF
BELLY PRESS
POPEYEPALPATION+++
PALM UP
SULCUS SIGNAR > 85°
HYPERABDUKTION
ANT. APPREHENSIONPOST. APPREHENSION
JOBE RELOCATION
RULE OF „3“