How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive...

13
11/27/2017 1 How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, M.D. Professor in Residence UCSF Department of Orthopaedic Surgery Chief, Sports Medicine and Shoulder Physical Examination-5 minute office exam Visual inspection Palpation Motion Cuff-Specific testing Biceps Testing

Transcript of How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive...

Page 1: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

1

How I do a 5 minute Comprehensive Examination of the Shoulder

C. Benjamin Ma, M.D.

Professor in Residence

UCSF Department of OrthopaedicSurgery

Chief, Sports Medicine and Shoulder

Physical Examination-5 minute office exam

Visual inspection

Palpation

Motion

Cuff-Specific testing

Biceps Testing

Page 2: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

2

Shoulder examination

Inspection• Patient in gown

Palpation

ROM

Strength

• Supraspinatus

• Infraspinatus & Teres minor

• Subscapularis

• Biceps

Other tests

Visual Inspection

Remove shirtSystematic

• Deltoid

• Supraspinatus

• Infraspinatus

• Biceps

• AC joint

• Skin changes

• Scars

Page 3: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

3

Shoulder examination

Inspection

PalpationROM

Strength

• Supraspinatus

• Infraspinatus & Teresminor

• Subscapularis

• Biceps

Other tests

Palpation

Press where it hurts

Location Diagnosis

Clavicle Clavicle fracture

AC joint AC joint arthritis

Trapezius/Neck Muscle strain

Front of shoulder Biceps pathology

Back of shoulder Arthritis

Page 4: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

4

RANGE OF MOTION

Active Range of Motion“What can you do?”Active Range of Motion“What can you do?”

Difficulty with active-check passiveDifficulty with active-check passive

No problemWith AROMNo problemWith AROM

No arthritisNo cuff tearNo frozen shoulder

No arthritisNo cuff tearNo frozen shoulder

No problem with passiveThink CUFF TEARNo problem with passiveThink CUFF TEAR

Problem with passiveThink Shoulder OA or Frozen Shoulder

Problem with passiveThink Shoulder OA or Frozen Shoulder

Rotator Cuff Testing

Impingement--Neer’s/Hawkins tests

Muscle Strength--Teres Minor--Infraspinatus--Supraspinatus--Subscapularis

Page 5: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

5

Pain test: Painful arc

JAMA. Rational clinical exam: Does this patient have rotator cuff disease? Aug 2013.

If painful, positive LR 3.7 for RCD.If not painful, negative LR 0.36 for RCD.

Pain test: Impingement signs

Hawkin’s Neer’sPhotos from Dr. Christina Allen

Page 6: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

6

Rotator Cuff Impingement

Park, et al. JBJS 2012

Hawkins’ Test

• 75% sensitive

• 49% specific

Neer’s Test

• 85% sensitive

• 44% specific

Supraspinatus

Jobe’s test

• 90º abduction

• 30º anterior flexion

• Internal rotation (palms down)

• Pain/weakness

• 53% sensitive/82% spec.

• (Park, et al. JBJS 12)

30°

Page 7: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

7

Infraspinatus

External rotation strength

0º abduction & 45º ER

Infraspinatus

Pain/strength test: Drop arm test

JAMA. Rational clinical exam: Does this patient have rotator cuff disease? Aug 2013.

Positive LR 3.3, negative LR 0.82 for rotator cuff disease.

Page 8: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

8

Subscapularis

Lift off testAbout 70% reliable(JAMA 2013)

Bear Hug testAbout 70% reliable(JAMA 2013)

Pain & Strength test:Subscapularis = internal rotation lag test aka ‘lift off ’

JAMA. Rational clinical exam: Does this patient have rotator cuff disease? Aug 2013.

Positive LR 5.6, negative LR 0.04 for full thickness rotator cuff tear.

Page 9: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

9

Biceps

Bicipital Tendonitis

• TTP at biceps groove

‒ Compare to other side

AC arthritis

Pain with palpation

Pain with cross chest adduction tests

Pain located at the AC joint

Page 10: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

10

Superior Labrum Anterior Posterior Lesion

O’ Brien’s Test

Adduction 15-20 deg

Forward Flexion 90 deg

Thumbs down

Resisted forward flexion

Positive test only when:

• Pain with the above position

• Pain diminishes when palm is supinated

• Otherwise equivocal test

Superior Labrum Anterior Posterior Lesion

SLAP lesion is a disease of the young individual

Sensitive test

Not a specific test

• Labral pathology

• Rotator cuff tendon tears

Page 11: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

11

Stability examination

Translational tests

• Anterior translation

• Posterior translation

• Inferior translation

Grading

• I – to the rim not over

• II – over the rim but spontaneously reduce

• III – locked dislocation

Load and Shift test

Slight joint compression

Anterior / posterior translation

Inferior pull for sulcus sign

Relax patient

Page 12: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

12

Instability tests

Apprehension sign

• Arm 90 deg abducted, 90 deg external rotation

• Dislocation position for anterior instability

Relocation sign

• Relieve of pain with a posteriorly directed force

‘Jerk’ sign

• Posteriorly directed force of the shoulder

• Pain with posterior instability

Physical examination

Examine the cervical spine

• Referred pain!!

• Range of motion

• Strength

Examine distal motor strength

• Peripheral nerve examination

Remember zebras

• Pain out of proportion

‒ Lung CA – Pancoast tumor

Page 13: How I do a 5 minute Comprehensive Examination of the Shoulder · How I do a 5 minute Comprehensive Examination of the Shoulder C. Benjamin Ma, ... rotator cuff tear. ... Microsoft

11/27/2017

13

Thank you

C. Benjamin Ma, M.D.

Professor in Residence

UCSF Department of Orthopaedic Surgery

Chief, Sports Medicine and Shoulder

(415) 353-7566

[email protected]


Shoulder Physical Examination Clinical Performance

Shoulder Physical Examination Clinical Performance

THE SHOULDER AND SHOULDER GIRDLE CH 17. TOPICS TO BE COVERED Examination, evaluation and assessment of shoulder joint Referred pain and nerve injury MANAGEMENT.

THE SHOULDER AND SHOULDER GIRDLE CH 17. TOPICS TO BE COVERED Examination, evaluation and assessment of shoulder joint Referred pain and nerve injury MANAGEMENT.

The Five-Minute Neurological Examination · 1 THE FIVE-MINUTE NEUROLOGICAL EXAMINATION Ralph F. Józefowicz, MD Introduction The neurologic examination is considered by many to be

The Five-Minute Neurological Examination · 1 THE FIVE-MINUTE NEUROLOGICAL EXAMINATION Ralph F. Józefowicz, MD Introduction The neurologic examination is considered by many to be

Clinical Examination Of Shoulder

Clinical Examination Of Shoulder

Frozen shoulder - EPUT€¦ · Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. Stages of frozen shoulder The symptoms of a frozen shoulder

Frozen shoulder - EPUT€¦ · Most often, a frozen shoulder can be diagnosed on examination, and no special tests are needed. Stages of frozen shoulder The symptoms of a frozen shoulder

Examination of shoulder joint

Examination of shoulder joint

Examination of the Shoulder

Examination of the Shoulder

Physical Examination of the Shoulder James A. Tom, MD Sports Medicine and Shoulder Dept. of Orthopaedic Surgery Drexel University College of Medicine Philadelphia,

Physical Examination of the Shoulder James A. Tom, MD Sports Medicine and Shoulder Dept. of Orthopaedic Surgery Drexel University College of Medicine Philadelphia,

Presentation1.pptx, ultrasound examination of the shoulder joint.

Presentation1.pptx, ultrasound examination of the shoulder joint.

Shoulder Examination Salient Points · Shoulder Examination and Salient Points ... translation of the arm with the shoulder is ... • Football, wrestling or basketball

Shoulder Examination Salient Points · Shoulder Examination and Salient Points ... translation of the arm with the shoulder is ... • Football, wrestling or basketball

18-Physical Examination of the Shoulder

18-Physical Examination of the Shoulder

Clinical Examination Shoulder - · PDF file20/06/2016 1 Physical Examination and common pathological conditions of the Shoulder Mr P Sarda Consultant Orthopaedic Surgeon CMFT Epidemiology

Clinical Examination Shoulder - · PDF file20/06/2016 1 Physical Examination and common pathological conditions of the Shoulder Mr P Sarda Consultant Orthopaedic Surgeon CMFT Epidemiology

Charlei goldberg musculoskeletal examination. knee and shoulder

Charlei goldberg musculoskeletal examination. knee and shoulder

Shoulder Examination and the Brachial Plexus. Structure of the Session Teaching – 30 minutes Shoulder Examination and the Brachial Plexus Move into small.

Shoulder Examination and the Brachial Plexus. Structure of the Session Teaching – 30 minutes Shoulder Examination and the Brachial Plexus Move into small.

12 - Clinical examination of the shoulder · shoulder or metastases can be a local source of shoulder pain. A Pancoast’s tumour of the lung often provokes pain in the shoulder area.

12 - Clinical examination of the shoulder · shoulder or metastases can be a local source of shoulder pain. A Pancoast’s tumour of the lung often provokes pain in the shoulder area.

Painful Shoulder - AANEM · 2007. 11. 9. · Painful Shoulder Contents Faculty ii Objectives iii Course Committee iv The Use of History and Physical Examination to Diagnose Shoulder

Painful Shoulder - AANEM · 2007. 11. 9. · Painful Shoulder Contents Faculty ii Objectives iii Course Committee iv The Use of History and Physical Examination to Diagnose Shoulder

Clinical Examination of the Shoulder Joint Complex · Clinical Examination of the Shoulder Joint Complex ... A. Dermatomes, myotomes, ... Upper limb tension test (ULTT) – Magee

Clinical Examination of the Shoulder Joint Complex · Clinical Examination of the Shoulder Joint Complex ... A. Dermatomes, myotomes, ... Upper limb tension test (ULTT) – Magee

7. Social Science-(EM) - education.rajasthan.gov.inChapter 6,7,8) Contemporary Indian ... 02 22 27-5 33 Minute 36 18 45 22-5 63 Minute 40 Minute orks related to examination) 10 Minute

7. Social Science-(EM) - education.rajasthan.gov.inChapter 6,7,8) Contemporary Indian ... 02 22 27-5 33 Minute 36 18 45 22-5 63 Minute 40 Minute orks related to examination) 10 Minute

Checklist for Physical Examination of the Shoulderunmfm.pbworks.com/w/file/fetch/112906198/Shoulder... · Drop Arm Test F. Referred Shoulder Pain Cervical Spine (disc disease) Myofascial

Checklist for Physical Examination of the Shoulderunmfm.pbworks.com/w/file/fetch/112906198/Shoulder... · Drop Arm Test F. Referred Shoulder Pain Cervical Spine (disc disease) Myofascial

ACUPRESSURE: SHOULDER PAIN · 2020-04-06 · ACUPRESSURE: SHOULDER . PAIN Technique: Press, Tap, or Circle Rub each point for 1 minute. Repeat 3-5 times.Stop if irritation occurs.

ACUPRESSURE: SHOULDER PAIN · 2020-04-06 · ACUPRESSURE: SHOULDER . PAIN Technique: Press, Tap, or Circle Rub each point for 1 minute. Repeat 3-5 times.Stop if irritation occurs.