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    Mike Shoulder Anatomy and Clinical Assessment of The Shoulder Mike BMUS SiG 2017

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    Mike Shoulder Anatomy and Clinical Assessment of The Shoulder Mike BMUS SiG 2017

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    loka janani
    44 views46 pages
    Fs

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    Mike Shoulder Anatomy and Clinical Assessment of the Shoulder Mike BMUS SiG 2017

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    44 views46 pages

    Mike Shoulder Anatomy and Clinical Assessment of The Shoulder Mike BMUS SiG 2017

    Uploaded by

    loka janani
    Fs

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 46

    Shoulder anatomy and

    clinical assessment of the


    shoulder
    Shoulder anatomy
    • Highly mobile joint where stability has been sacrificed for mobility.

    • Shoulder girdle comprises:


    • Glenohumeral (ball and socket) joint
    • Acromio-clavicular joint
    • Scapula sitting on thoracic wall / rib cage (“floating” joint)
    Glenohumeral (ball and socket) joint

    Courtesy Nicki Delves


    Glenohumeral (ball and socket) joint

    Courtesy Nicki Delves


    Glenohumeral (ball and socket) joint

    Courtesy Nicki Delves


    Glenohumeral (ball and socket) joint
    Coraco-acromial ligament (CAL)

    Courtesy Nicki Delves


    Glenohumeral (ball and socket) joint
    • Rotator Cuff muscles
    Glenohumeral (ball and socket) joint
    • Rotator Cuff muscles

    Courtesy Dr Kai Win


    Subscapularis

    TeachMeAnatomy.info

    Courtesy Nicki Delves


    Supraspinatus

    TeachMeAnatomy.info
    Infraspinatus

    TeachMeAnatomy.info
    Bursae

    Courtesy Kate Norris & Nikki Meredith


    Rotator cuff tendons

    Rotator Int

    Courtesy Nicki Delves


    Biceps tendon in rotator interval

    Courtesy Nicki Delves


    Biceps tendon in rotator interval

    Courtesy Nicki Delves


    Rotator interval

    Courtesy Nicki Delves


    Rotator interval

    Courtesy Nicki Delves


    Biceps tendon

    Courtesy Nicki Delves


    Acromio-clavicular joint

    © Lydia Kibuk (2000)


    Courtesy Dr Kai Win
    Acromio-clavicular joint

    © Lydia Kibuk (2000)


    Courtesy Dr Kai Win
    Acromio-clavicular joint

    © Lydia Kibuk (2000)


    Courtesy Dr Kai Win
    Scapula sitting on thoracic wall / rib cage

    Fastbleep.com
    Scapula sitting on thoracic wall / rib cage

    Fastbleep.com Musculoskeletalkey.com
    Scapula sitting on thoracic wall / rib cage
    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Instability

    Courtesy Nicki Delves


    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Acromio-clavicular joint

    © Lydia Kibuk (2000)


    Courtesy Dr Kai Win
    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    Frozen shoulder; GHJ OA

    Courtesy Nicki Delves


    Taken from http://www.ouh.nhs.uk/shoulderandelbow/information/documents/JRFinal2010poster.pdf
    “Impingement”

    Courtesy Nicki Delves


    Bursal involvement

    Courtesy Kate Norris & Nikki Meredith


    Rotator cuff tears
    Some orthopaedic tests
    www.shoulderdoc.co.uk – so far 129 found
    • Empty can test
    • Pain, muscle weakness • Others:
    • Hawkins Kennedy • Anterior apprehension
    • Scapular assistance test

    • Various rotator cuff tests

    • Neer impingement test


    • Scapular held down, examiner passively
    abducts the arm
    • ACJ
    Scarf test
    “Ask the questions you felt too self-conscious to ask”

    • The management of certain • Q. What is the difference between


    conditions, post scan, e.g. tendinosis and tendinopathy? When
    1. Calcified tendinopathy, in its varying do you use the terms in reporting?
    forms; perhaps comparison of clinical Symptomatic non symptomatic
    management over barbotage.
    2. Adhesive Cap - in its varying stages • Q. What thickness should
    and when more urgent Physiotherapy Supraspinatus be, age affecting etc
    fits in.
    This can empower the sonographer to • Q. Should we always comment on
    gauge the clinical significance of the impingement?
    scan findings and to be able to discuss
    this in an informed way with the
    patient.
    “Ask the questions you felt too self-conscious to ask”

    • does a specific orthopaedic test mean the patient has a particular


    pathology?
    • should I try and reproduce their symptoms when I scan them?
    • if they have neck pain then is there any point in scanning them?
    • what is actually causing pain at the shoulder?
    • is a frozen shoulder the only reason for a stiff shoulder?
    • what are the 3 things I should ask before I scan them?
    • what are the 3 things I should do to them / ask them to do before I scan
    them?
    • what should I tell them if I find a tear, calcific deposit, etc?
    Special Tests – all taken from previous MSK SiG
    presentation by Eoghan Murray
    • ‘‘it is not possible to make a definitive diagnosis with the clinical tests currently in use’’ (Lewis, J & Tennent, D., 2007)
    • ‘’Currently, almost without exception, there is a lack of clarity with regard to whether common tests used in clinical examination
    are useful in differentially diagnosing pathologies of the shoulder’’ (Hegeduset al. 2008)

    • No test is absolutely diagnostic of a particular shoulder pathology


    •No test series capable of selectively assessing r/c + S.A bursal tissues + integrity of the S.A space
    •All clinical tests stretch and/or compress S.A bursae
    •Reduce specificity and ability to differentiate

    • Difficult to isolate individual tendons and other structures and inform accurate diagnosis:
    • –r/c morphology -r/c cable
    • –Position + innervation of sub-acromial bursae
    • –Lack of correlation between symptoms and imaging, U/S + MRI
    •Tests reasonably reliable when used in combination and in context to clinical
    Special Tests (cont)
    • Validity of the Tests
    • Neer72% sensitivity, 60% specificity
    • Hawkins Kennedy 79% sensitivity, 59% Specificity
    • Painful arc 53% sensitivity, 76% specificity
    (Hegaduset al., 2012)

    • Impingement Tests:
    • –Relatively high sensitivity but low specificity
    • –Substantially decreases utility in deriving a specific diagnosis.
    • •Not all structural failure correlates with symptoms

    • Tests reasonably reliable when used in combination and in context to clinical picture.

    •Testing must be used in conjunction with the subjective history


    •Combination of tests provides more conclusive diagnosis
    Special Tests (cont): radiological correlation?

    • Poor correlation between structural failure and symptoms


    •R/C pathology related to age

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