1 / 70

P hysical E xamination of the U pper E xtremiti es

P hysical E xamination of the U pper E xtremiti es. BY ABDULLAH RADWAN. Shoulder Examination. ANATOMY Bones Joints Muscles Bursae Nerves Blood supply. SHOULDER JOINTS. Glenohumeral Scapula thoracic Acromio-clavicular Sterno-clavicular. Clinical Anatomy. Deltoid

sorenson
Download Presentation

P hysical E xamination of the U pper E xtremiti es

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PhysicalExamination of the UpperExtremities BY ABDULLAH RADWAN

  2. Shoulder Examination ANATOMY • Bones • Joints • Muscles • Bursae • Nerves • Blood supply

  3. SHOULDER JOINTS • Glenohumeral • Scapula thoracic • Acromio-clavicular • Sterno-clavicular

  4. Clinical Anatomy Deltoid Rotator cuff Teres major Latissimus dorsi Biceps Pectoralis muscles

  5. Clinical Anatomy Rotator Cuff Supraspinatus ABD Infraspinatus ER Teres minor ER Supscapularis IR Depress humeral head against glenoid to allow full abduction

  6. Clinical Anatomy Bursae subacromial subdeltoid subscapular

  7. Physical Examination • Inspection • Palpation –pression • Range of motion examination • Neurological examination • Special tests for the shoulder problems • Examination of the related areas

  8. Shoulder Inspection • Anterior side • Posterior side • Lateral side • Medial side

  9. Physical ExamInspection Front & back Height of shoulder and scapulae Muscle atrophy, asymmetry

  10. SHOULDER PALPATION and PRESSION • Bones • Joints • Muscles • Bursae • Nerves • Lymph nodes

  11. SHOULDER Range Of Motion • Flexion-180 degree • Extension -45 degree • Abduction -180 degree • Adduction -30 degree • Internal rotation -90 degree • External rotation -90 degree

  12. Physical ExamRange of Motion Forward flexion: 0o – 180o

  13. Physical ExamRange of Motion • Extension • 0o – 40 to 60o

  14. Physical ExamRange of Motion • Internal rotation • 80-90o • External rotation • 80-90o

  15. Neurological Examination of the Shoulder Muscle tests : • Flexion • Extension • Abduction • Adduction • Internal rotation • External rotation

  16. Muscle testing scoring • 0 No contraction • 1 Flicker or trace contraction • 2 Active movement, with gravity eliminated • 3 Active movement against gravity • 4 Active movement against gravity and resistance • 5 Normal power

  17. Shoulder Abduction muscle test

  18. Shoulder flexion and extension muscle test

  19. Shoulder external and internal rotation muscle test

  20. Shoulder abduction and adduction muscle test

  21. Neurological Examination of the Shoulder sensory tests : • C4 • C5 • C6 • C7 • C8 • T1 • T2

  22. Special Tests for the Shoulder Problems • Yergason test –biceps tendinitis • Neer impingement test-acromioclavicular impingement • Drop arm test –rotator cuff tear • Resisted flexion (Speed)test –biceps tendinitis • Resisted abduction(Supraspinatus) test-supraspinatus lesion • Aprehension test –glenohumeral joint instability

  23. Yergason test • Yergason test for biceps tendon instability or tendonitis. • The patient's elbow is flexed to 90 degrees, and the examiner resists the patient's active attempts to supinate the arm and flex the elbow.

  24. Drop Arm Test Passive abduction to 90° Instruct patient to slowly lower arm At 90° abducted arm will suddenly drop, may need to add slight pressure (+) drop = (+) test

  25. SHOULDER PAINSPECIAL TESTS Neer PASSIVE Forced forward flexion of arm with internally rotated shoulder Test is positive if pain occurs at same point as with active forward flexion

  26. Speed’s Maneuver • Forward flex the shoulder against resistance while maintaining the elbow in extension and the forearm in supination. Pain or tenderness in the bicipital groove in dicates bicipital tendinitis.

  27. Rotator Cuff Strength Testing Weakness on exam Grade strength on 0→5 scale Compare to other side

  28. Apprehension Test/Relocation Test

  29. Differantial Diagnosis for shoulder pain • Subacromial impingement syndrome • Adhesive capsulitis –frozen shoulder • Biceps tendinopati • Bursitis • Rotator cuff pathology • Glenohumeral joint pathology • Acromioclavicular joint pathology • Sternoclavicular joint pathology • Myofascial pain syndrome • Radiating or referred pain from cervical spine

  30. Subacromial Impingement • Neer proposed that 95% of rotator cuff tears are due to chronic impingement between the humeral head and the coracoacrominal arch.

  31. Subacromial Impingement • Stage 1 disease consists of edema and hemorrhage of the tendon due to occupational or athletic overuse, and is reversible under conservative treatment.

  32. Subacromial Impingement • Stage 2 disease shows progressive inflammatory changes of the rotator cuff tendons and the subacromial-subdeltoid bursa, and can be treated by removing the bursa and dividing the coracoacromial ligament after failed conservative management.

  33. ELBOW EXAMINATION • Anatomy • Evaluation • Inspection-Observation • Palpation-Pression • Range of motion • Neurological examination • Special tests • Examination of related areas

  34. ELBOW ANATOMY • Bones • Joints • Ligaments • Muscles

  35. Elbow Anatomy Medial Elbow

  36. ElbowAnatomy Lateral Elbow

  37. ELBOW Anatomy

  38. EVALUATION INSPECTION • Anterior –posterior side • Medial-lateral side • Carrying angle • Swelling

  39. PALPATION and PRESSION Bone palpation : • Lateral epicondyle • Radial head • Medial epicondyle • Olecranon

  40. SOFT TISSUE PALPATION Medial aspect • Ulnar nerve • Wrist flexor –pronator group • Medial collateral ligament Lateral aspect • Wrist extensors (ECRL-ECRB) • Lateral collateral ligament • Annular ligament

  41. SOFT TISSUE PALPATION Anterior aspect • Cubital fossa • Brachial artery • Median nerve • Musculo-cutaneus nerve Posterior aspect • Olecranon bursa • Triceps tendon

  42. ELBOW ROM • Flexion -135 degree • Extension -0 degree • Pronation -90 degree • Supination -90 degree

  43. NEUROLOGICAL EXAMINATION Muscle tests: • Flexion - Extension • Pronation - Supination Sensation tests • C5-C6-C7-C8-T1 Reflex test: • Biceps reflex –C6 • Brachioradial reflex –C6 • Triceps reflex-C7

  44. Elbow Reflex testing • Biceps reflex –C6 • Brachioradial reflex –C6 • Triceps reflex-C7

  45. SPECIAL TESTS • Ligament tests (varus-valgus stres test) • Tennis elbow test • Golfers elbow test • Tinels sign for ulnar nerve

  46. Ligament tests (varus-valgus stres test)

  47. Tennis elbow test

  48. Golfers elbow test

  49. Tinels sign for ulnar nerve

  50. COMMON ELBOW PROBLEMS • Lateral epicondylitis • Medial epicondylitis • Olecranon bursitis • Fractures • Triceps tendinitis • Post immbolization capsular tightness (contracture)

More Related