1. Examination of Upper Joints Flashcards
What is the anatomical name of the Shoulder Joint?
The Gleno-humeral joint
Are we confined to the G-H joint or are there more joints?
No. It is a complex of 4 joints, namely the :-
- Acromio-clavicular Joint
- Sterno-clavicular Joint
- Gleno-Humeral Joint
- Scapulo-thoracic Joint
Why are these 4 joints important?
Because they facilitate the movement of the Shoulder
What the organs involved when there’s referred pain around the Shoulder?
REFERRED PAIN
- Neck
- Lungs
- Diaphragm
- Heart
- Upper back
What are the common symptoms seen around the Shoulder joint?
COMMON SYMPTOMS OF SHOULDER JOINT
- Pain
- Swelling
- Deformity
- Stiffness
- Impingement*
- Aphrension*
What is the procedure for examination of the Shoulder Joint?
- Inspection
- Palpation
- Movement
- Measurement
- Neurological Examination
- Special Tests
What is important in Inspection?
- Attitude of the Limb & Shoulder
- Shape of the Shoulder
- Swelling
- Deformity
- Skin
- Muscle wasting
- Limb length discrepancy
Carried out on all angles (front, back, sides & axilla)*
What is the first thing you should ask the patient do before conducting the examination?
Ask the patient for consent and if given, ask patient to place the limb in it’s anatomical position.
How would you examine the front of the Shoulder?
SHOULDER FRONT EXAMINATION
- Inspect the shape of the Shoulder
- Inspect for deformities / abnormalities on the Clavicle and it’s surroundings
- Inspect Supraclavicular / Infraclavicular area for abnormalities
- Inspect for wasting of Pectoralis major
- Inspect the ‘Anterior Axillary Fold’ for swelling and compare the level of axilla on both sides
- Inspect for any swellings, deformities, skin changes, scars, sinuses, infection, engorged veins and muscle wasting
- Inspect for Limb Length Discrepancy
What are the commonly seen abnormal skin changes in examination?
- Ecchymosis
- Bruising
What does presence of engorged veins on examination indicate?
Presence of a tumour
What does presence of a scar on examination indicate and what course of action would you take upon this discovery?
It could be due to surgery. Ask patient if it’s due to surgery or natural healing.
I’d inspect if it is a primary or secondary scar.
How would you examine the side of the Shoulder?
SHOULDER SIDE EXAMINATION
- Inspect the shape of the shoulder (N = circular contour)
- Inspect for swellings
- Inspect for deformities
- Inspect the prominence of the Acromion process
- Inspect for skin changes
- Inspect for wasting of Deltoid muscle
- Inspect for sinuses, infections and engorged veins
How would you examine the back of the Shoulder?
SHOULDER BACK EXAMINATION
- Inspect the Scapula and Upper back for swellings, scars, sinuses and deformities
- Inspect the spine of the Scapula for any deformities.
- Inspect for wasting of the Suprascapular and Infrascapular muscle
- Inspect the Superior and Inferior angle of the Scapula and compare it with the opposite side
- Inspect the Medial border of the Scapula for Winging of the Scapula
- Inspect the level of posterior axillary fold and compare it with the opposite side
- Inspect for skin changes such as Ecchymosis and bruises
If the level of the Posterior Axillary Fold is lower on one side, what does it indicate?
It indicates the presence of swelling on the lower side
How would you carry out the examination of the Axilla?
AXILLARY EXAMINATION
- Inspect the Axilla for any swelling, scars, sinuses and abnormalities.
- Observe for a globular mass. If present, palpate for tenderness.
What is an important differential diagnosis to be considered when a swelling in the Axilla is observed?
Luxatio - Erecta
It could be the dislocated head of the Humerus
Once you’re done with Inspection, what will you do?
Proceed to Palpation
How will you carry out Palpation of the Shoulder Joint?
PALPATION OF SHOULDER
- Observe for local rise of temp.
- Observe for tenderness
- Confirm all inspectory findings
- Look for evidence of bony irregularities
- Confirm the levels of bony prominences on both sides
- Completes neurological and vascular examination
- Examination of neck, elbow, cardiac and resp. sys.
Once you’re done with Palpation, what will you do?
Proceed to examination of Shoulder Movements
How would you examine the movements of the Shoulder?
Ask the patient to carry out all range of movements of BOTH shoulders, both ACTIVE and PASSIVE which has to be observed and recorded in all directions in degrees.
How many movements is the Shoulder capable of and name them.
24 movements
Flexion, Extension, Adduction, Abduction, Internal and External Rotation (Active and Passive on both sides)
After observing movements, what will you do?
Record the measurements of the Shoulder
What measurements on the Shoulder would you take?
- Apparent measurement
- True measurement
What are the 2 lengths recorded in True Measurement?
- Total Length
- Segmental Length
What is Total Length?
Total length is the limb length, measured from tip of Acromion till tip of Radial process.
Compare the limb length of both limbs, if there’s shortening, find the exact location.
What is Segmental Length?
Segmental Length is the length measured to determine the exact location of shortening.
In case of Upper Arm shortening, there are 2 lengths to be measured, the Humeral and Radial Length.
How is Humeral Length measured?
It is measured from the tip of the Acromion to the Lateral epicondyle
How is Radial Length measured?
It is measured from tip of lateral epicondyle to tip of Radial process
