By Todd S. Ellenbecker DPT MS SCS OCS CSCS
Useful, clinically centred, and hugely illustrated, this new advisor comprises content material now not coated in the other publication, offered in a straight forward structure. half I introduces the techniques of subjective overview, observation/posture, comparable referral joint checking out, neurovascular checking out, palpation, and variety of movement trying out. half II contains the majority of the textual content, overlaying the main shoulder checks that clinicians practice. half III beneficial properties supplemental assessments utilized in the scientific surroundings. eventually, half IV pulls all of the details jointly by means of checking out scholars and clinicians alike with a sequence of case experiences. The reader also will locate broad, updated references for additional learn or study.
- The first textual content committed completely to the musculoskeletal exam of the shoulder joint.
- Emphasizes learn and objectivity, offering quick access to present study quantification of try approach efficacy indication and medical application.
- Contains an exhaustive evaluate of exam and scientific exams, resulting in a extra actual analysis and higher process care.
- Presents a mix of medical assessments, sensible assessment parameters, throwing and period activity return/evaluation tactics, in addition to seldom-presented closed chain assessments, providing the practitioner a plethora of other tests.
- Highlights new checks for the shoulder, really within the sector of labral and instability testing.
- Places a excessive measure of emphasis on documentation of attempt effects, expanding the reader's objectivity of the shoulder examination process.
- Includes quite a few combos of sufferer presentation, emphasizing vintage diagnoses and the combos of attempt effects from the review strategies coated within the textual content. Case reviews let readers to check themselves and observe their wisdom to various situations.
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Extra resources for Clinical Examination of the Shoulder
Qxd 5/24/04 4:30 PM Page 33 CHAPTER 5 Related Referral Joint Testing Table 5-1 33 Shoulder Pain Right Shoulder Systemic Origin Location Peptic ulcer Myocardial ischemia Hepatic/biliary: Acute cholecystitis Liver abscess Gallbladder Liver disease (hepatitis, cirrhosis, metastatic tumors) Pulmonary: Pleurisy Pneumothorax Pancoast’s tumor Kidney Lateral border, right scapula Right shoulder, down arm Right shoulder; between scapulae; right subscapular area Right shoulder Right upper trapezius Right shoulder, right subscapula Ipsilateral shoulder; upper trapezius Ipsilateral shoulder Systemic Origin Left Shoulder Location Ruptured spleen Myocardial ischemia Pancreas Ectopic pregnancy (rupture) Left Left Left Left Pulmonary: Ipsilateral shoulder; upper trapezius Pleurisy Pneumothorax Pancoast’s tumor Kidney Postoperative laparoscopy shoulder (Kehr’s sign) pectoral/left shoulder shoulder shoulder (Kehr’s sign) Ipsilateral shoulder Left shoulder (Kehr’s sign) From Goodman C, Snyder T: Differential diagnosis in physical therapy, ed 3, Philadelphia, 2000, WB Saunders.
The examiner stands on the same side of the patient’s shoulder being examined. Using clasped hands (Figure 5-4), the heels of the hands are located near the midpoint of the clavicle anteriorly and on the spine of the scapula posteriorly. With a compressing-type action, the anterior hand presses posteriorly on the clavicle, while the posteriorly placed hand presses anteriorly on the spine of the scapula in an oscillating-type pattern. Several oscillations of movement are performed, with particular attention paid to both the amount and quality of the motion with bilateral comparison carried out.
This position places the supraspinatus tendon just off the anterolateral aspect of the acromion and allows the patient’s extremity to be examined in a position of greater comfort that nearly all patients can achieve, even after a surgical procedure (Figure 7-1) (Hawkins & Bokor, 1990). The infraspinatus and teres minor tendons insert on the lower facets of the greater tuberosity of the humerus, and several positions have been recommended for palpation. Cyriax and Cyriax (1993) and Magee (1997) both recommended using a position where the patient is prone on elbows, with the affected shoulder in slight ﬂexion, adduction, and lateral rotation.