Name:
How To Clinically Examine a Painful Shoulder
Description:
How To Clinically Examine a Painful Shoulder
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Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Let's learn how to examine a painful shoulder and we go through inspections, special tests and try to see where the pain is coming from. So when we start, the most important point in the history is where is the pain? For example, if the pain is more still in a middle aged guy or a young guy at some particular spot, it's localized.
And if you do an MRI, you often see sometimes there is a cyst in the spiniglenoid notch. This is a paralabral cyst which lodge at the notch and compress the parascapial nerve, causing a lot of shoulder pain and weakness and capsulitis. Now, if the pain is more superiorily yeah, and you ask the patient to localize the pain, and if he does so at the AC joint and you do an MRI X-Ray, you sometimes see fusion because of AC synovitis and that is the cause of pain which is coming from the AC joint.
Now, interior painful shoulder is very easy to diagnose since this is because of a supraspinatus rupture. Now if the pain is more diffused all around the shoulder exteriorly and low down also. This is typically coming from a capsule like this. Now, when you see a shoulder all exposed from front and behind, sometimes you see a muscle atrophy in the infraspinatus fossa.
And also this denotes a long standing investment or rupture or a massive cuff tear. So now let's move on to physical examination. This will be in two stages. You're going to examine the range of movement and the muscle testings of individual shoulder muscles. So and when you move on and do the range of movement examination, I want you to do this.
I want you to always do active passive movement and compare it to normal times. So you're going to record elevation and degrees and acceleration one with elbow by the site. So rotation two with elbow at 90 degree abducted an internal tissue, everything is going to be active, passive and compared with the other side. So let's see the elevation first. Now I ask the patient to actively just elevate the hands up as much as he can and see if both are gentle or there is some difference.
Or just try to. See if it's restricted or not. Not here. It's one or two degrees normal. Next, you go for external rotation with the elbow by the side of the body. This we are calling ER 1. So the elbow is aductor and patient is asked to external rotate forearm.
And you see both the sides the same on this ER. Now you move on to we are to how we do the ER 2 to is with the elbow areducted at 90 degrees and then ask the patient to external rotate. Now we want to see both sides are identical or not. 90 degrees is normal for many people. So we move on to internal rotation. So we ask the patient to reach out at their back with the hand, with one hand first and then with the other hand.
And then you see here if both are identical or not. Look here, if she could take her hand up to seven or even further up and that is quite normal then you see. I didn't go with the other hand or at this stage we should be very clear in your mind that the movements are restricted or not because a diagnosis of capsulitis can be made after this examination if your shoulder movements are passively restricted or not.
For example, in this gentleman there is a restriction of both active and passive movements, as will be seen here. This guy here has a restriction of forward elevation and also external rotation. And this limitation is both active and passive, as we see here.
So he cannot take his hand beyond 90 degrees.
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