pe_muscskelexam
40 pág.

pe_muscskelexam


DisciplinaPropedêutica Clínica167 materiais1.725 seguidores
Pré-visualização3 páginas
and Teres Minor \u2013
Posterior View
RC Testing - Subscapularis
Anatomy: Connects scapula to 
humerus, w/origin on anterior 
surface of scapula. 
FiringÆinternal rotation. 
Function can be tested using 
"Gerber's lift off test:" 
1. Patient places hand behind 
back, palm facing out. 
2. Pt lifts hand away from back. 
3. If tendon partially torn, 
movement limited or causes 
pain. Complete tears 
prevents any movement in 
this direction
Sucscapularis \u2013 Anterior View
Impingement, Rotator Cuff Tendonitis and 
Sub-Acromial Bursitis
\u2022 4 tendons of RC pass 
underneath acromion/coraco-
acromion ligamentÆ insertions 
on humerus. 
\u2022 Space between 
acromion/coracoacromial lig & 
tendons can become narrowed 
\u2022 Causes tendons (in particular, 
supraspinatus) to become 
"impinged upon.\u201dÆresulting 
friction inflames tendons & 
subacromial bursa (between 
tendons & acromion). 
\u2022 Net result =s shoulder pain, 
particularly raising arm over 
head (e.g. swimming, reaching 
up on a top shelf, arm 
positioning during sleep).
eOrthopod.com
Anatomy - Impingement 
and Bursitis
Neer\u2019s Test For Impingement 
1. Place 1 hand on 
patient's scapula, & 
grasp forearm 
w/other. Arm 
internally rotated 
(thumb pointed 
downward). 
2. Foreward flex arm, 
positioning hand 
over the head. 
3. PainÆ
impingement. Shoulder Anatomy Fig 5 - AAFP 
Evaluation Painful Shoulder
Hawkin\u2019s Test For Impingement 
and Subacromial Palpation
Hawkin\u2019s Test:
1. Raise patient's arm to 90 
degrees forward flexion. 
2. Rotate internally (i.e. thumb 
pointed down)Æplaces greater 
tubercle humerus in position to 
further compromise space 
beneath acromion. 
3. PainÆ impingement. 
Subacromial Palpation:
1. Identify acromion by following 
scapular spine laterally to tip
2. Palpate in region sub-acromial 
spaceÆ pain if tendons/bursa 
inflamed.
Subacromial Palpation
Shoulder Anatomy Fig 5 -
AAFP Evaluation Painful 
Shoulder
Biceps Tendon \u2013 Anatomy and Function
\u2022 Long head biceps tendon 
runs in bicipital groove 
humerus, inserting @ top 
of glenoid.
\u2022 Subject to same 
forces/stresses as 
tendons of RC.
\u2022 Biceps flexes & 
supinates forearm; also 
helps flex.
\u2022 Inflammation 
(tendonitis)Æpain @ top 
& anterior shoulder 
areas, particularly 
w/flexion or supination.
eOrthopod.com
Anatomy \u2013 Biceps Tendon
Rupture
Biceps Tendon Testing and 
Pathology
Palpation:
1. Palpate biceps tendon bicipital 
groove. PainÆtendonitis.
2. Confirm you\u2019re on tendonÆ
patient supinates while you 
palpate
Resisted Supination (Yergason\u2019s 
Test):
1. Elbow flexed 90 degrees, 
shoulder adducted (ie elbow 
bent @ right angle, arm against 
body). 
2. Grasp patient's hand, direct 
them to rotate arm such that 
hand is palm up (supinate) 
while you resist. 
3. PainÆtendonitis
Palpation Yergason\u2019s
\u201cPopeye Muscle\u201dÆBicep\u2019s Rupture
Popeye The Sailor
Acromio-Clavicular Joint Pathology
\u2022 A-C joint minimally mobile. 
Inflammation & 
degenerationÆ shoulder 
pain.
Specifics of Testing: 
1. Palpate point @ which end 
of clavicle articulates 
w/acromion. 
2. Push on areaÆ ? pain
3. Ask patient to move arm 
across chestÆstresses A-C 
jointÆ pain in setting of 
DJD.
4. A-C joint separationÆ
swelling & pain on cross arm 
testing or palpation
Palpation of A-C Joint
A-C Joint Testing - Fig 7 - AAFP 
Evaluation Painful Shoulder
eOrthopod.com
Anatomy \u2013 A-C Joint Pathology
\u25a1 Observation, palpation General orientation
\u25a1 Range of motion (flexion/extension, abduction/adduction, 
internal/external rotation), with palpation
Decreased with variety shoulder pathology, crepitus on 
palpation with DJD
\u25a1\u201cEmpty can test\u201d (arm abducted 60 degrees, forward 
flexed ~ 30 degrees, thumb down, resistance to additional 
flexion)
Pain/weakness suggests Supraspinatus tear
\u25a1 Resisted external rotation Pain/weakness suggests Infraspinatus or Teres Minor tear
\u25a1 Resisted internal rotation and lift off from back (Gerber\u2019s 
test)
Pain/weakness suggests Subscapularis tear
\u25a1 Sub-acromial palpation Pain suggests bursitis/impingement
\u25a1 Hawkin\u2019s test (elbow 90 degrees, arm forward flexed 90 
degrees, examiner internally rotates)
Pain suggests bursitis/impingement
\u25a1 Neer\u2019s test (thumb down, elbow straight, examiner raises 
arm thru forward flexion)
Pain suggests bursitis/impingement
\u25a1 Long head biceps palpation Pain suggests biceps tendonitis
\u25a1Yergason\u2019s (elbow 90 degrees, arm adducted, patient 
attempts supination while examiner resists)
Pain suggests biceps tendonitis
\u25a1A-C joint tenderness, Cross arm test (reach across 
towards opposite shoulder)
Pain suggests a-c joint pathology (djd, dislocation)
Maneuver Clinical Interpretation
Summary of Maneuvers \u2013 Shoulder Exam
	Musculoskeletal Examination: General Principles and Detailed Evaluation Of the Knee & Shoulder
	General Principles
	Historical Clues
	Examination Keys To Evaluating Any Joint
	Terminology: Flexion/Extension, Abduction/Adduction
	Knee Anatomy:\ufffdObservation & Identification of Landmarks
	Observation (cont)
	Range of Motion (ROM)
	Assessment For A Large Effusion - Ballotment 
	Menisci \u2013 Normal Function and Anatomy
	Evaluating for Meniscal Injury \u2013 Joint Line Palpation
	Additional Tests For Meniscal Injury McMurray\u2019s Test \u2013 Medial Meniscus
	McMurray\u2019s Test \u2013 Lateral Meniscus
	Additional Assessment For Meniscal Injury \u2013 Appley Grind Test
	Ligaments \u2013 Normal Anatomy and Function
	Specifics of Testing \u2013 Medial Collateral Ligament (MCL)
	Lateral Collateral Ligament (LCL)
	Another Method For Assessing The LCL and MCL
	Anterior Cruciate Ligament (ACL) \u2013 Lachman\u2019s Test
	Drop Lachman\u2019s Test\ufffdFor Patient\u2019s With Big Legs &/or Examiners With Small Hands
	Posterior Cruciate Ligament (PCL) \u2013 Posterior Drawer Test
	Anterior Knee Pain: Assessment for Patellofemoral Problems and Chondromalacia
	Slide Number 23
	The Shoulder Exam\ufffdOverview of Anatomy
	Anatomy \u2013 Anterior View
	Observation & Palpation
	Active Range Of Motion\ufffdFlexion/Extention and Abduction/Adduction
	ROM Cont \u2013 Internal/External Rotation
	Passive ROM
	The Rotator Cuff
	RC Testing \u2013 Supraspinatus\ufffd(\u201cempty can test\u201d
	RC Testing \u2013 Infraspinatus and Teres Minor
	RC Testing - Subscapularis
	Impingement, Rotator Cuff Tendonitis and Sub-Acromial Bursitis
	Neer\u2019s Test For Impingement 
	Hawkin\u2019s Test For Impingement and Subacromial Palpation
	Biceps Tendon \u2013 Anatomy and Function
	Biceps Tendon Testing and Pathology
	Acromio-Clavicular Joint Pathology
	Slide Number 40