examination of shoulder joint

The test result is positive if the patient cannot maintain the position. Posture in the standing and seated positions should be observed for a forward set, protracted head, and rounded shoulders (humeral internal rotation and scapular protraction), which will cause functional narrowing of the subacromial space. test deltoid and pectoralis major power and also for winging of the scapula. After initial standard supraspinatus testing (Jobe test), the medial border of the scapula is stabilized by the examiner, and muscle testing is repeated. The literature suggests that a positive Jobe test is sensitive and moderately specific for a tear of the supraspinatus tendon. They cite a personal communication with Speed in 1952 and describe the test as follows ( Fig. Doing the basic aspects of a musculoskeletal examination is especially important in the shoulder: The key to performing a good shoulder examination is to develop a system in which the patient is prepped so you can (1) see the shoulders; (2) compare both sides; (3) do a neurovascular examination; and (4) consider the joint above, which in this case is the cervical spine. Then, we can carry on some specialized tests that will help us uncover any lesions of the muscular or ligamentous structures of the joint. The Neck 4.1 ). A test result is considered positive when the patient cannot keep the hand on the shoulder and it pulls away. The suprascapular nerve (C5–C6) innervates the supraspinatus and infraspinatus, which originate from the supraspinatus and infraspinatus fossa, respectively. Confirm the patient’s name and date of birth. The scapular assistance test involves assisting the lower trapezius by stabilizing the upper medial border of the scapula and rotating the inferomedial border as the arm is abducted or adducted. There are no studies that validate the Neer test. Merely knowledge of test is not enough, good practice is essential to perform the tests. Adequately expose the patient’s upper bodyand provide a blanket to cover the patient when not being examined. (Reproduced with permission from Bowen MK, Warren, RF. Shoulder examination comprises of examining the shoulder girdle as a whole which consists of 1. This test has never been studied clinically, but palpation of the long head of the biceps tendon is not typically reliable in the proximal arm. (Redrawn from McFarland EG: TK Kim, HB Park, G El Rassi, H Gill, E Keyurapan: Examination of the Shoulder: The Complete Guide, New York, Thieme, 2006, pp 162-212 Fig 2.4. The second is with the hands on the hips with the fingers anterior and the thumb posterior with about 10 degrees of shoulder extension. Pain should radiate into the deltoid region. Gill and coworkers found that Speed’s test had a sensitivity of 50%, specificity of 67%, PPV of 8%, NPV of 96%, and likelihood ratio of 1.51 for detecting partial tears of the biceps tendon. With the arm in this position and the thumb in internal rotation, this test is known as the “Jobe test.” However, subsequent study has found that the test has equal validity whether the thumb is pointing down, neutral, or up. The neutral position is with the arm and forearm in the horizontal plane ( Fig. Prime movers about the shoulder girdle shown on magnetic resonance imaging (. The latissimus dorsi is supplied by the thoracodorsal nerve (C6–C8) and has a large origin of the spinous processes of T6 to the sacrum, the thoracolumbar fascia, iliac crest, and the caudal three ribs while inserting onto the floor of the intertubercular groove. In addition, a thorough sensorimotor examination of the upper extre… One study found that only 5% of patients with superior labral tears have a click, but 5% of a control group also had a click. The attachments of the muscles to the scapula are noted in Figure 4.4 . They write: … the examiner supports the patient’s elbow in 90 degrees of forward elevation in the plane of the scapula while the patient is asked to rotate the arm laterally in order to compare the strength of lateral rotation. Indicated, the starting position is the lift-off maneuver joint for the third position is with the hands the. These maneuvers accurately and understanding their reliability and validity are paramount to a shoulder... 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