Reider, Bruce. The orthopaedic physical exam/Bruce Reidernd edition. p. cm. ISBN 1. Physical orthopedic tests. 2. Physical diagnosis. I. Title. Clinical Examination: A Systematic Guide to Physical Diagnosis. 1, Pages· · The orthopaedic physical exam/Bruce Reidernd edition. p. cm. Reider 2nd Ed. - Ebook download as PDF File .pdf), Text File .txt) or read book online. Data Reider, Bruce The orthopaedic physical exam/Bruce Reider. The same can be said for the orthopaedic physical examination: Although the.
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Bruce Reider - The Orthopaedic Physical Exam (, Saunders).pdf - Ebook download as PDF File .pdf), Text File .txt) or read book online. Examination 1st Edition. by Bruce Reider AB MD (Author) Netter's Orthopaedic Clinical Examination: An Evidence-Based Approach (Netter Clinical Science). Bruce Reider, AB, MD, Professor of Surgery, Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of Surgery, The University of Chicago;.
The superior border of the trapezius and the origin of the posterior third of of the scapula is covered by the trapezius and supraspina- the deltoid.
Because it is covered completely by the trapez- Figure It inserts on the superior angle of the scapula. Hyperinternal rotation of the processes and inserts on the spine of the scapula.
Injury to this nerve. Winging is most com- ridge of bone oriented at right angles to the main plane of monly the result of weakness of the serratus anterior.
It is innervated by the posterior roots of C2 to C4. These include deltoid. The rhomboid mus- cles arise from the nuchal ligament and spinous processes of C7 through T5 and insert on the posterior medial bor- der of the scapular spine. Even then. They are innervated by the dor- sal scapular nerve and function by elevating and adducting the scapula. The rhomboids are not normally distinctly seen but may be visible in a patient with spinal accessory nerve palsy.
This mus- cle is not normally visible but may be seen in a patient with a spinal accessory nerve palsy.
Despite these muscular attachments. The trapezius originates from the occiput. The most visible bony feature of the pos. It begins at the medial border of the scapula weakness of the rhomboids or trapezius may produce dif- and proceeds toward the supraiateral corner of the ferent types of winging.
Winged right scapula. Its serrated ori- gins can be seen in the axilla of lean muscular individuals Fig. The posterior third of the deltoid. Although the serratus itself is not usually vis- ible. The serratus anterior arises from the outer surface of the upper eight or nine ribs and inserts on the deep surface of the medial scapula. If it is entrapped at the spinoglenoid notch dis- tal to the innervation of the supraspinatus.
The infraspinatus arises from the supe- before it enters the supraspinatus. In the case of posterior dislocation of the shoul-. Left supraspinatus and infraspinatus atrophy due to a rounded lateral border of the posterior aspect of the suprascapular nerve palsy. Weakness or denervation of the serratus due to long tho- racic nerve injury results in the classic.
Atrophy of the of the humerus posterior to the supraspinatus insertion. It can be atrophied in both capular nerve at the suprascapular notch. Serratus Anterior. Dynamic tests to bring out this winging are described later in this chapter. If the suprascapular nerve is compressed Infraspinatus. In manual laborers and indi- viduals who participate frequently in sports such as base- ball or tennis. Anterior to this groove.
In Sprengel's deformity. When a shoulder is painful. In most individuals. Although the examiner may view the shoulder from above Fig. Posterior to this groove lies the muscle belly of the triceps brachii. The usual resting position can vary widely arm is straightforward Fig. Prominent serratus anterior arrows in a muscular wrestler. Some people tend to carry longitudinal groove runs down the upper arm from the their shoulders with their scapulae retracted toward the axilla toward the elbow.
Whether the patient is viewed a well-known congenital malformation. Overhead view of the normal right shoulder. The groove itself marks the location of the Differences between the two shoulders can exist. Imaginary lines drawn between paired land- marks such as the sternoclavicular joints or acromioclav- der. The axillary sheath. The inclination of the toward the observer. A measurement from the inferior tip of the dominant scapula to the midline that is at least 1.
The Shoulder. The patient's uninvolved side can In throwing athletes. WB Reider B: Sports Medicine: The School-Age Athlete. From Rockwood Figure Active ROM is normally assessed first.
WB Saunders. From CA Jr. The normal range of some motions such as abduction and forward flexion is fairly consistent among normal individuals. Medial aspect of the upper arm. This tion usually differ between the dominant and the non- abnormality can be detected by measuring the distance dominant limbs. Measuring to detect a lateral scapular slide. Sprengel's deformity left shoulder. This has been called the lateral scapular slide.
Palpable step off. Multiple motor and sensory deficits Figure Active shoulder abduction. Minimal internal-external rotation of gleno- humeral j o i n t. A b n o r m a l shoulder contour Posterior dislo- cations are the most frequently missed.
Often the If There is a History of Trauma: S m o o t h passive internal and external rotation. Locked passive internal and external rotation. Locked internal and external rotation. To evaluate abduction. Grinding or crepitus. The examiner grasps the position.
This shrugging of the shoulder produces a characteristic appearance that is frequently seen in the presence of rotator cuff injury but may be observed in other conditions as well.
Shrugging of the scapula to increase abduction right shoulder. If glenohumeral motion is restricted by arthritis or a painful. Another phenomenon that may be detected while testing active abduction is painful arc syndrome. If the patient is able to continue abduct- ing through the pain. The smooth coordination of these two components of abduction is often called the scapulo- humeral rhythm. The patient her arms forward in the sagittal plane as far as possible should be alerted before performing such a test.
A painful arc phenomenon suggests the possibility of an impinged or torn rotator cuff. Forward Flexion. When passive Forward flexion may also be limited in the presence of abduction dramatically exceeds active abduction. Although the patient often sponta- neously reports or reveals the pain by facial expression.
In painful arc syndrome. Forward flexion is usually the next If abduction is far from complete. Rotator or torn rotator cuff is the most common cause.
The patient is asked to lift his or should evaluate passive abduction Fig. Passive shoulder abduction. Painful arc of abduction. In this somewhere between strict forward flexion and abduction. The patient is then instructed to externally scapular stabilizers can also limit active forward flexion.
The patient is asked to place both arms ness or tendon injury. The Society of American elbows firmly against the sides of the trunk Fig. Active shoulder flexion. Rotation can be measured in two positions: If forward flexion is significantly limited. This may mean injury to the rota. When the examiner releases the forearm.
It may be slightly greater on the dominant than the nondominant side. Massive tears that involve the pos- When total active elevation is assessed. Shoulder and Elbow Surgeons recommends measuring Normal external rotation in this position may vary from total active elevation rather than flexion or abduction.
This plane is usually to externally rotate even to a neutral position. To assess external passive forward flexion that is significantly greater than rotation at the side. Whether measured at the side or in limit both. Externally rotated position. The patient starts in the same neutral position as for external rotation and is asked to internally rotate the arm at the shoulder Fig.
This is particularly true in limbs may be assessed simultaneously or in sequence. Normal external rotation in this position motion than external rotation at the side because it simu. When measured in this position. To measure full inter- nal rotation. This maneuver is sometimes called the. Neutral position. To assess internal rotation at the side.
Internal rota- tion in this position. It is important for the examiner to detect this tendency. Passive external rotation. Both than on the nondominant side.
When external rotation is limited. External rotation ai the side. In such patients. Internal rotation may also be tested in both posi- tions. The throwing athletes. This measures pure internal rotation.
In the presence of anterior shoulder instability. Patients with back. This is normally about T7 for women by the nearest landmark reachable: Apley scratch test. This motion is usually quanti. Remembering that the iliac crests mark the extension of the shoulder is necessary to move the hand level of the L4-L5 interspace. It is a very functional motion. Most individuals are able to reach the posterior superior iliac spine.
This is a complex motion. The most direct is to have the patient start reach across the body and try to place the hand on or past with the arm at the side and swing the upper extremity the opposite shoulder as far as possible Fig.
A more functional way to measure adduction is called this. Behind the back Apley's scratch test. Internal rotation limited to posterior iliac crest. In this test. This motion may be quanlitated if desired by meas- cross-chest or cross-body adduction.
Internal rotation with arm at side. Nondominant arm. Normal adduction in this position is about over the opposite shoulder. To abdomen. Adduction may also be measured in two dif.
This is most commonly felt best at the supramedial corner of the scapula. Because pure shoulder extension is not frequently used in daily activities. Protraction and retraction are movements that take place at the scapulothoracic interface.
In scapular protraction. Cross-chest adduction. This motion may be painful or limited in patients with acromioclavicular joint pathology. In the presence of snapping scapula syndrome. The scapulae are noted to approach each other as they move toward the midline Fig. The patient is asked to swing the upper limb as far posteriorly as possible in the sagittal plane while keeping the elbow straight Fig.
Normal shoulder extension is much less than forward flexion. They are usually not measured but observed in a qualitative way. To demonstrate scapular retraction. The scapulae are seen to slide away from the midline Fig. Shoulder extension is tested in a manner opposite to that of shoulder flexion. It is not marks that are occasionally visible. Posterior view. Palpation can also be helpful in the presence of a tioned in the Surface Anatomy section.
In such a case. Palpation gests that the arthritic joint itself is contributing to the should be avoided where inspection has already yielded a patient's pain and is not merely an incidental finding.
Eliciting tenderness at the joint sug- sionally. Lateral view. Tenderness tle swelling may be present. The examiner looks for the it is usually redundant as well as unkind to palpate an obvi. These include land. This section acromioclavicular joint due to the accretion of asympto- highlights areas in which palpation tor tenderness or.
Because the clavicle is so super. Scapular retraction. Many areas of possible palpation have already been men. The examiner then pushes ficial. When acromioclavicular joint or fractured clavicle. Pushing downward on the clavicle and upward on the arm helps identify the acromioclavicular joint. Scapular protraction. Through overuse or trauma. Passively extending the patients. The examiner then palpates Subacromial Bursa.
Palpation can also be iner cannot distinguish the actual outlines of the coraco. To palpate the long head biceps tendon. The sternoclavicular joint line can usually be patient's shoulder brings more of the subacromial bursa palpated approximately 1. Knowing that the lig. Other areas of bony palpation can be valuable frequently. Gentle palpation of the clavicle for localized tenderness may be helpful if a fracture is suspected from the patient's history but no visible deformity is observed.
Palpation of the subacromial bursa. Biceps tendinitis may some- mally painless. Bony crepitus should never be actively sought during such palpation. Palpation of the coracoclavicular ligaments. The subacromial bursa underlies fairly deeply between the coracoid process and the clavi. Its purpose is to help the rotator cuff gests injury to the coracoclavicular ligaments. It is not usually necessary to pal. Eliciting tenderness can be particu- aments run from the coracoid superiorly to the overlying larly crucial in the presence of nondisplaced fractures of clavicle.
To palpate the ster. By default. The long head biceps acromionale. Long Head Biceps Tendon. Palpation of the acromion see Fig. Tenderness of the subacromial bursa is Acromion. This groove usually become painful. When a full thickness tear of Sternoclavicular Joint. Eliciting tenderness in this interval sug. Although the exam. This latter possibility is discussed in between a deltoid whose contraction is present but weak Chapter 3. Mild injuries of this sort examining finger. To palpate biceps tendon itself cannot be distinctly felt.
Myositis ossificans can occur in the biceps or under- lying brachialis following contusion. A clinical situation in Biceps Muscle. Isometric contraction of the pectoralis major facilities Figure Except in cases of extreme deltoid atrophy. Biceps ruptures most commonly cation or shoulder stabilization surgery. Palpation of the long head of the biceps tendon arrow. Palpation can be helpful in the pres- Fig.
In the presence of isolated biceps tendinitis. Palpation of the biceps muscle belly is which this is particularly useful is following acute dislo- occasionally helpful. These are most commonly axillary nerve injury. If such uation. As in the thigh. Special tests for biceps Palpation of the deltoid muscle can be helpful when an tendinitis are discussed in the Manipulation section.
Elbow and Forearm. The examiner then identifies the biceps tendon distally and palpates along it proximally until the point of maximal tenderness is reached. In these situa- involve either the long head tendon proximally or the dis.
To palpate the deltoid in such a sit- situated at the distal musculotendinous junction. Tenderness Starting palpation over the pectoralis major muscle belly.
In the case of an intratendinous tear or avulsion. If the examiner boids. The examiner should be able to while the patient is asked to alternately protract and feel the deltoid tense as the patient abducts isometrically. Moderately firm palpation in this groove close to the axilla allows the examiner to appreciate the pulsations of the brachial artery. This in these areas may not reliably distinguish between these soft spot identifies the superior portion of the gleno- two diagnostic possibilities.
Palpating the acromion Fig. This distinct sensation. Pain in these areas may represent a local muscle palpates a point approximately 1 cm medial to the pos- injury. Finding ten- index and long fingers of the examiner's other hand are derness of the bony scapula may alert the examiner to placed with light to moderate pressure on the patient's the possibility of a subtle fracture that could be over- deltoid approximately 1 cm lateral to the lateral border of looked on routine shoulder radiographs.
The ful in cases of suspected scapular fracture. Even when the primary humeral joint between the humeral head and the glenoid pathology appears to be in the cervical spine.
Finding tenderness to palpation a soft spot approximately 1. Palpating a distinct del. Palpation for snapping scapula. Firmer palpation along the groove allows the examiner to appreciate the bony resistance provided by the medial aspect of the humerus see Fig. What the patient describes as posterior shoulder pain A useful landmark of palpation posteriorly is the so- may often be localized to the trapezius or upper rhom.
A needle inserted through this spot associated with a tender trigger point at the site of and aimed at the palpated tip of the coracoid process referred pain. The median and ulnar nerves travel with the artery in this part of the arm. This landmark is useful for injection of the ing to the trapezius or upper rhomboids frequently is glenohumeral joint.
Palpation for lateral deltoid contraction. If the weakness is subtle. In severe cases. When these muscles are weak or denervated. These are deep mus- they interact in a complex fashion. Assessing rhomboid strength scapular retraction. An alternative method for demonstrating serratus anterior weakness is to have the patient attempt to raise the arms Figure The rhomboids are innervated against the thorax and allow it to function as the founda- tion of the upper extremity.
If serratus anterior function is completely lost owing to a long thoracic nerve palsy. The serratus ante- rior is innervated by the long thoracic nerve. Demonstration of scapular winging right shoulder. The serratus anterior originates from the anterior ribs and inserts on the medial border of the scapula. The rhomboids are responsible for retrac- Many muscles are active about the shoulder and arm. When scapular stabilization is ineffective. This may be one muscle. The examiner stands behind the patient in order to best observe winging and may provide additional resistance with the palm of the hand.
It is rarely possible to cles that are covered by the trapezius. To look at the truly test a single muscle in isolation. The classic test for serratus anterior weakness is to ask the patient to perform a modified pushup against the wall.
Within those limitations. Weakness of this muscle manifests itself as wing- ing of the medial border of the scapula. The teres minor would be a unit. The supraspinatus and Fig. When the trapezius is weak. In this situation. Isolated weakness of the infraspinatus XI.
Impingement or thus is paralyzed if a complete axillary nerve palsy tearing of the rotator cuff tendon usually begins with the occurs. Assessing trapezius strength. To test the infraspinatus. The trapezius is innervated by cranial nerve Infraspinatus. As a rotator cuff tear teres minor is overshadowed by the profound loss of progresses.
The trapezius is a large superficial muscle that The supraspinatus is evaluated using the supra- dominates the junction of the posterior shoulder and spinatus isolation test Jobe test. The teres minor. To perform the test. The supraspinatus muscle lies deep to The teres minor is innervated by the axillary nerve. The patient is then asked to externally rotate the only to rotate but also to stabilize the humeral head in the arms while the examiner provides resistance glenoid fossa during abduction.
One of The patient is then asked to push toward the ceiling while the examiner's hands provides resistance through down. Isolated palsy of this nerve. Weakness ward pressure on the acromion while the other can pal.
As noted earlier. The patient is then instructed to adduct the arm against the examiner's resistance Fig. The latissimus dorsi is a large internal rotator and extender of the arm. To test the latis- simus dorsi. Assessing infraspinatus and other external rotators. Supraspinatus isolation lest. The examiner may resist this motion with both hands while visually confirming the latissimus Figure The patient is instructed to press the hand down against the abdomen while the examiner pectoralis major is a large triangular muscle that adducts attempts to lift the patient's hand away from the trunk and internally rotates the arm at the shoulder.
Pectoralis major muscle strength may be tested by asking the patient to forward flex the shoulder with the elbow slightly bent. The pec- Fig. The first is the subscapularis liftoff test. This test is described in the Manipulation section. This method is particularly helpful in assess- toralis major can be observed for function and continuity ing the strength of the subscapularis in patients with by asking the patient to compress the hands together in restricted internal rotation.
The muscle is innervated by the medial and lateral pectoral nerves see Fig. The patient is then instructed to attempt to internally rotate and extend the arm at the shoulder as if attempting to climb a ladder Fig.
Latissimus Dorsi. The pectoralis major can be observed to contract and its strength may be estimated.
If a pectoralis major rupture is present in a lean male. The humeral internal rotators are portion can still be palpated where it crosses the anterior large and superficial.
Assessing subscapularis and other internal rotators. It arises from the back and constitutes the posterior border of the axilla as it courses to its insertion on the humerus. In the second method. Subscapulars strength can be graded in two ways. Pressing the hands The subscapularis is innervated by the upper and lower together in this position causes an isometric contraction subscapular nerves.
The axilla to insert on the humerus. To test the anterior Figure Injury to this nerve results in a latissimus dorsi weakness Fig. The patient is then instructed to attempt to further flex the arm while the examiner provides resistance at the distal arm. The exam- Figure The deltoid muscle is divided into three portions.
Assessing latissimus dorsi strength. Assessing pectoralis major strength. In the pres- ence of a paralyzed deltoid. The axillary nerve is the most common peripheral nerve to be injured during shoulder dislocation or surgery.
The primary function of each of the three deltoid heads can be predicted by its position: The latissimus dorsi is innervated by the thoracodorsal nerve. Latissimus dorsi atrophy arrow. The rotator cuff muscles assist the deltoid in this function by stabilizing the humeral head in the gle- noid fossa. The patient is asked to place the arm in is tested by asking the patient to extend one shoulder a slightly abducted position.
The examiner then pro. Deltoid strength testing. The musculocutaneous nerve is also some- times injured at the shoulder. Its cutaneous branch supplies an area over the lat- eral deltoid sometimes described as a shoulder patch Fig.
Present day clinicians are not always careful to make the distinction between the terms impingement sign and impingement test as Neer originally described them. Sensation Testing The axillary nerve is the peripheral nerve at greatest risk for injury during shoulder trauma.
Charles Neer proposed the concept massive rupture of the tendinous cuff. Strength testing of the biceps and triceps is therefore described in Chapter 3. Testing for axillary nerve sensory deficit. Neer made the distinction between a rotator cuff impingement sign and an impingement test.
The discomfort of impingement may often be increased by flexing the patient's elbow and internally rotating the shoulder before performing the impinge- ment sign Fig. Several findings of the impingement syndrome. They may vary from reversible bursitis and overuse tendinitis to frank Impingement Sign. Pain that is elicited by the Neer impingement sign and eliminated by the subacromial injection of local anesthetic is usually caused by rotator cuff impingement or tear.
To elicit the Neer impingement sign. Special Tests humeral rhythm during abduction. Reproduction of the patient's symptomatic pain at maximal forward flexion is designated a positive impingement sign and is considered evidence of impingement syndrome Fig. He named this procedure the [Neer] impingement test. This maneuver is thought to bring the pathologic anterolateral acromion into contact with the affected portion of the rotator cuff and greater tuberosity. The Hawkins impingement reinforcement Figure When the impingement sign is painful.
Several other manipulative tests have been Disorders of the rotator cuff complex are among the most described for detecting rotator cuff disease. Its sensory branch is the lat- eral cutaneous nerve of the forearm lateral antebrachial cutaneous nerve. Testing for sensory deficit of the sensory branch of the side of the forearm Fig. Another impingement test was described by Hawkins. Neer recom- mended injecting local anesthetic in the subacromial bursa and repeating the impingement sign.
The dropping sign. The patient is asked to main- Fig. The examiner then externally rotates the arm out to patient's shoulder to the maximal degree possible maximal external rotation. Droparm test. The patient flexed position. The production of pain cuff tear.
Neer's impingement sign. A releases the patient's arm and asks him or her to slowly normal individual should be able to maintain the arm in Figure The examiner then passively internally present. After warning the patient. When a droparm sign is Fig. Hawkins' impingement reinforcement test. As with the Neer impingement test. Modified Neer's impingement sign. This maneuver is felt to drive the greater then loses control of the arm. The dropping and Hornblower signs are signs of tear- A similar maneuver has also been described for eliciting ing and fatty degeneration of the infraspinatus and teres pain in the rare syndrome of coracoid impingement minor muscles respectively.
A d r o p a r m sign usually indicates a large rotator and coracoacromial ligament. Improvement in the droparm sign follow- or subacromial bursa. Subscapularis strength can also be evaluated by determine the size and chronicity of rotator cuff tears. This sign is as specific and more Subscapularis Injury.
The arm position is the same. The examiner then ation have a worse prognosis after tendon repair. These tests can be helpful in determining the back. It is performed by placing the patient's palm Figure A pulls the arm into a position of maximal internal rotation suprascapular nerve palsy p r o d u c e s an a b n o r m a l without causing the patient pain.
The examiner maintains the patient's shoulder the patient's hand rests on the back Fig. This test is abnormal Fig.
Gerber significant damage to the infraspinatus tendon and described the subscapularis liftoff test as a physical sign of accompanying muscle atrophy Fig. Dropping sign. If the arm drifts involved in the most massive rotator cuff tears and also back toward the position of neutral rotation.
The arm is then released.
Strength can be graded in the normal fashion. The belly press test is an additional test for subscapu- scapularis inserts on the lesser tuberosity. Normal Strength. The ability to perform this maneuver is if the arm falls into internal rotation. Fig the other three components of the rotator cuff. It is occasionally laris weakness. These two tests are used to scapularis. Unlike sensitive than the liftoff test.
The flexion while instructing the patient to maintain the patient is then asked to lift the hand off the back elbow perpendicular to the floor. Subscapulars injury is rare. To perform the subscapularis The Hornblower sign is performed by passively liftoff test.
The examiner then rotates the weakness. The examiner then grasps the patient's left elbow is then instructed to press the hand firmly against the with his or her left hand.
The examiner's right hand is placed strong pressure. This soft tis- Passive Rotation Test. Hornblower's sign. Passive rotation in the abducted sue crepitus. To perform this test on the left shoulder. The examiner's hand is the examiner stands behind the patient. Subscapularis liftoff test. The patient flexed. In the presence of significant subscapularis on the patient's shoulder.
Abnormal Figure Belly press test. Patient with weak subscapulars. Subscapularis lag sign. The patient is then instructed to maximally internally rotate the shoulder so that the thumb is pointing down.
This maneuver often reproduces the SLAP lesion is an acronym Superior Labrum Anterior to patient's pain if acromioclavicular joint injury or arthritis Posterior coined by Snyder to indicate tears of the supe- is present. The patient then externally rotates the shoulder so that the palm is up. Passive cross-chest adduction may also The O'Brien test or active compression test was origi- be used as a test for acromioclavicular joint symptoms.
Passive cross-chest adduction. In the O'Brien test. The location of the pain is thought to identify the site of the pathology: This sign should be correlated with other rotator cuff can also lightly palpate the patients acromioclavicular tests because popping may be present when the subacro.
Passive shoulder rotation to elicit soft tissue crepitus. The term tion Fig. As already noted. The patient is told to note the presence and location of pain during this maneuver.
While performing the maneuver. The test is considered positive and reliable if the patient experiences pain during the thumbs down portion of the test and an improvement or absence of pain in the thumbs up position. Internal rotation portion. The stability examination has two goals. Biceps load test. The first group of tests tries to directly quantitate the amount of Figure The arm is placed in the apprehension position of abduction and external rotation. The first is to document the presence and direction of instabil- ity.
The second is to quantitate the amount of laxity pres- ent. In this test the patient is placed in the supine position. There are two types of test for shoulder stability. The patient is then asked to flex the elbow against resistance. It is important to remember that instability is a clinical diagnosis that is usually made on the basis of a suspicious history combined with the appropriate physical findings. The biceps load test was described to help identify SLAP lesions in the presence of anterior instability.
External rotation portion. Once the patient starts feeling apprehensive. An increase in apprehension or discomfort is positive.
O'Brien's test. Subscapularis lag sign subscapularis episode is pathognomonic of anterior instability. Abnormal relocation test. In the pres- -Weakness to resistive testing of involved ten. In the cooperative. Impingement signs variable in the supine position. Although such an. Relevant Physical Exam: This position simulates the most.
To internal rotation perform it. Visible atrophy more severe tears. Abnormal jerk sign supine. Impingement signs present variable laxity will vary depending upon the individual. A b n o r m a l relocation test anterior apprehension test suggests that a patient may have. Injury occurred in flexion adduction and is the classic provocative test for anterior instability.
It is important to remem. Increased posterior laxity to load and shift slight extension with the elbow flexed. These tests attempt to provoke the patient's symp.
A b n o r m a l apprehension crank test. Abnormal apprehension test. Increased anterior laxity to load-and-shift and multidirectional instability and that the predominantly drawer tests symptomatic direction is anterior. These two types of tests are therefore. Abnormal jerk test Relevant Physical Exam: Normal apprehension test patient.
O r positive jerk sign position of instability. A b n o r m a l apprehension and abnormal and stop as soon as the patient indicates a feeling of relocation tests apprehension or confirms that the test reproduces the.
Injury occurred in abduction and external complementary. Negative impingement sign.
The apprehension test crank test. Impingement signs present common position of subluxation or dislocation in the. Droparm sign. Abnormal lift-off and belly-press test patient with an unstable shoulder.
Pain w i t h active and or passive motion patient with symptomatic anterior instability. Hornblower's expressing concern or anxiety or even preventing the sign more severe tears desired position from being achieved.
To perform this test. The possibility of an internal impinge- ment syndrome. To perform the drawer test. In this con- dition.
Apprehension test. The examiner may even be able to exter. The purpose of this force is to push the coracoid process. Release test. Anterior a n d Posterior Laxity. When this happens the patient experiences pain rather than appre- hension in response to the apprehension test. To examine the patient's right shoul- patient feels pain or apprehension see Fig.
Releasing or easing the posteri- orly directed force at this point should cause the patient's pain or apprehension to return. Reduction or resolution of the patient's pain or bilize the scapula and thus the glenoid fossa. Abduction-external rotation causes these two structures to come into contact while the relocation maneuver decompresses them.
This syndrome tends to be associated with more minor degrees of abnor- Figure This portion of the maneuver may be called the release test Fig. Pain in the apprehension position is suggestive. The exam- apprehension by this posteriorly directed force tends to iner then grasps the humeral head between the thumb confirm the impression of symptomatic anterior instabil. The der. The drawer and load- The relocation test was developed to increase the speci.
Internal impingement is a recently described syndrome in which the apprehension and relocation tests may also both be relevant. To ity Fig. Relocation test. The examiner's left index finger is placed on the patient's iner's free hand. Posterior translation. Anterior translation. Starting position. Drawer test A. The amount of translation is sulcus test is performed. To assess anterior laxity. A rationale for treatment.
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