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Shoulder Joint examination Overview PowerPoint Presentation

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Description : Check out this medical presentation on Orthopaedics, which is titled "Shoulder Joint examination Overview", to know about Shoulder Joint examination.

Tags : Orthopaedics, Shoulder Joint examination

Published on : Aug 10, 2021 | Views : 2745 | Downloads : 4

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Slide 1-

Shoulder Joint examination Overview Introduction Presentation Examination Anatomy Investigations Injections Key points A J Chakrabarti FRCS(Orth)
Slide 2-

Introduction Shoulder pain is very common Can be Recalcitrant Many get better spontaneously without treatment Costly
Slide 3-

Introduction Prevalence Overall 7% 26% in elderly Rheumatology 2006;45:215–221
Slide 4-

Shoulder Pain in Adults 50-80% Do not present Manages 80% Rxs 20% Community Primary Care Secondary Care
Slide 5-

Not getting better spontaneously What is the actual diagnosis? Are there specific considerations for this particular patient? When should I refer?
Slide 6-

Shoulder examination Basic steps History Examination Clinical tests Investigations XR/US What is the diagnosis ? Don’t be too hasty in simply diagnosing “Frozen shoulder”
Slide 7-

Patient factors of importance Lifestyle Occupation Handedness Sports/Hobbies PMH / PSH DH Expectations Previous treatments
Slide 8-

Shoulder Complaints Pain Stiffness Instability Weakness/ Functional loss Swelling Deformity Electrical disturbance/ Vascular disturbance
Slide 9-

Shoulder Complaints Pain That keeps patient awake at night
Slide 10-

Shoulder Complaints Pain Keeps partner / spouse up! Groan
Slide 11-

Shoulder Complaint Pain Onset Injury Duration Site Severity Nature Periodicity Timing Night pain Exacerbating Relieving factors Treatments tried Tablets Response to Rxs
Slide 12-

Shoulder Complaint Pain Injury Nature Bleeding/ Bruising Snap. Crack “General Feel” Position of arm Pre-existing state
Slide 13-

Site of Pain Radiating to forearm/hand infrequent Radiating to neck Does not arise form intrinsic shoulder problems (except ACJ- to base of neck)
Slide 14-

Shoulder Complaint Pain Open Palm v Finger sign Deltoid sited pain Subacromial space / Rotator cuff. GHJ Superiorly sited pain Acromioclavicular joint
Slide 15-

Shoulder Instability Traumatic Atraumatic GLL Muscle patterning disorder History of fits Event Ease Frequency Subtle instabilities Pain Dead arm
Slide 16-

Shoulder Weakness Pain causes weakness Weakness of muscles –neural, musculotendinous or other mechanical Patients exact meaning Association with any pain.
Slide 17-

Painful Shoulder Remember that pain experienced in the shoulder can arise from outside the shoulder
Slide 18-

Shoulder Complaints Neck Brachial plexus pain Viscera. Intrathoracic/ subphrenic Chronic regional pain syndromes
Slide 19-

Shoulder Complaints Neck Brachial plexus pain Viscera. Intrathoracic/ subphrenic Chronic regional pain syndromes
Slide 20-

Shoulder examination Multiple techniques No best single way! Compare sides
Slide 21-

Assessing a Shoulder Anatomic sites Glenohumeral joint Acromioclavicular joint Sternoclavicular joint Subacromial space Rotator Cuff Scapulothoracic articulation Think anatomically ! Three True Joints Three areas
Slide 22-

The Rotator cuff 4 muscles with their tendons acting as a functional unit to maintain the humeral head centered on the glenoid
Slide 23-

The Rotator cuff
Slide 24-

Clinical Examination Look Feel Move Stand Sit Lie
Slide 25-

Clinical Examination Inspection Localising Tenderness Neck Examination CxSp Neuro exam Functional assess Elevation Impingement ER IR Abduction RPA Cuff testing 3 pt Biceps
Slide 26-

Minimum 10 point Clinical Examination Inspection Localising Tenderness Neck Examination CxSp Neuro exam Functional assess Elevation Impingement ER IR Abduction RPA Cuff testing 3 pt Biceps
Slide 27-

Minimum 10 point examination
Slide 28-

Empty can Impingement Positive Comparative increased pain No pain But slower Block
Slide 29-

The Hallmarks of common diseases Cx stiffness/ pain: Cervical spondylosis / Cx disc prolapse Elevation restriction: RCT lifting with good arm Impingement sign: Bursal/cuff disease or ACJ impingement Restrictions of Global GHJ motion: Capsular contracture of Frozen shoulder or OA GHJ Loss of resisted muscle power: RCT or pain inhibition Painful resisted cuff activity: RCT/ impingement LHB signs: Biceps tendinopathy
Slide 30-

Clinical Judgement Neck Shoulder ACJ BURSA CUFF BICEPS CAPSULE AND JOINT SURFACE 10 point examination
Slide 31-

Shoulder Scores of function Oxford Shoulder Score 48 12 Questions – all relate to shoulder in last 4 wks 0-4 per question. Max score 48/48 = Gd shoulder Worst,Dressing,Car,Knife,Shopping,Tray Brush,Usual,Robes,Axilla,Housewk,Night
Slide 32-

Does it need an XR? Yes: If referring for surgical opinion Yes: If you need it to corroborate your diagnosis Yes: If possibility of calcific disease Yes: If need to exclude arthrosis (The arthrosis of ACJ The arthrosis of the GHJ) Yes: If concerned re: malignant disease
Slide 33-

What XR’s do I find valuable? AP 30° Caudal Axillary Lateral Stryker Notch view for GHJ instability Clavicular views for ACJ instability
Slide 34-

“Sourcil” sign
Slide 35-

30° Caudal view - useful to gauge 3D anatomy of Acromion
Slide 36-

30° Caudal view
Slide 37-

Ultrasound examination Examines the rotator cuff Supraspinatus Infraspinatus Subscapularis Teres Minor Long Head Biceps Bursa / Impingement
Slide 38-

Ultrasound examination DO NOT REQUEST IN PREFERENCE TO PLAIN XR FILM
Slide 39-

MRI? Access to the films is the most important The reports may be misleading. The MRI has a picture that both clinician and patient can understand Most useful when: ACJ impingement a possibility Other pathologies /multiple pathologies are expected Limited use without contrast: calcific disease/ instability
Slide 40-

Treatments In all cases Conservative. Analgesia Physiotherapy: Pendular exercises Theraband exercises Eccentric Deltoid exercises “eccentric means lengthening during loading” Steroid injections Other injections / other treatments
Slide 41-

Treatments Theraband exercises
Slide 42-

Steroid Injections Prep the skin and draw up solution with separate needle to one used to inject. Portal: Soft spot – Below Postero-lateral corner Aim for Anterior acromion for bursal injection Aim for Coracoid process for GHJ injection Superior Summit for ACJ
Slide 43-

Cures for shoulder diseases? Arthritis ACJ: Excision arthroplasty Arthritis GHJ: Total shoulder replacement/ Hemi Rotator Cuff Arthropathy: Reverse polarity prosthesis Acute Rotator Cuff Tears: RCR Impingement with/without Tears: ASAD Instabilities: Various stabilizations
Slide 44-

Conditions that may not be cured Chronic Calcific Disease: Massive Cuff Tears: Degenerative RCTears without arthritis: Poor vascularity Secondary fatty infiltration and neural change to muscle/tendon unit Patients unfit for surgery: Conservative management: Steroid injections/ Eccentric Deltoid Training/ Suprascapular Nerve Blocks
Slide 45-

Prognosis in shoulder conditions is largely determined by the condition of the rotator cuff and The outcome following surgery in most cases largely determined by the condition of the rotator cuff