Shoulder
The glenohumeral joint is the most mobile joint in the body with a large degree of range of motion. Along with this increased mobility comes a higher degree of instability due to a shallow and smaller glenoid as compared with the humeral head, which can l
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Shoulder Aaron Jay Yang and Nitin B. Jain
Introduction
Physical Examination
• The glenohumeral joint is the most mobile joint in the body with a large degree of range of motion. Along with this increased mobility comes a higher degree of instability due to a shallow and smaller glenoid as compared with the humeral head, which can lead to subsequent shoulder injuries. Pathology related to the rotator cuff is the leading cause of shoulder pain and can often present with pain, weakness, and loss of range of motion. However, the differential diagnosis of shoulder pain can be broad and includes labral tears, glenohumeral ligament tears or sprains, acromioclavicular ligament tears, osteoarthritis, adhesive capsulitis, peripheral neuropathy, and cervical radiculopathy. As a result, a thorough examination should include the cervical spine and the contralateral shoulder.
• Inspection should include the muscle bulk, position of the scapula, and the position of the neck in relation to the shoulders. Patients may commonly present with rounded shoulders and a forward head posture which can subsequently lead to humeral internal rotation and scapular protraction. In cases of chronic massive rotator cuff tears, the humeral head can be superiorly displaced and abut the acromion. • Scapula: Important anatomical landmarks include the superior angle of the scapula which corresponds to the 2nd rib, the spine of the scapula to the third thoracic vertebrae (T3) and the inferior border of the scapula to T7. ◦ The scapula can be tilted or “winged” depending on the etiology of weakness. As the patient resists forward flexion of the shoulder or does a wall push-up, weakness of the serratus anterior secondary to a long thoracic nerve injury may cause the scapula to wing medially. However, when there is weakness of the upper trapezius secondary to spinal accessory nerve injury, the scapula may wing laterally with resisted arm abduction. This can be measured by the distance from the spinous processes to the medial border of the scapula with side to side comparison
A.J. Yang, MD (*) • N.B. Jain, MD, MSPH Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way Suite 1318, Nashville, TN 37212, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_12
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A.J. Yang and N.B. Jain
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• Palpation ◦ Biceps tendon: palpation of the long head of the biceps tendon is performed in the bicipital groove between the lesser and greater tuberosity of the humeral head. Pain with internal and external rotation during palpation indicates potential tendinosis of the biceps tendon. ◦ The acromioclavicular (AC) joint: is palpated for tenderness by following the distal end of the clavicle to the AC joint, palpating for tenderness along the joint, which indicates potential AC joint sprain or osteoarthritis. • Range of motion of the shoulder includes forward flexion, extension, internal/external rotat
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