Upper extremities 1 Shoulders

a. Note normal contour or "squaring" caused by deltoid atrophy. Palpate anteriorly for soft-tissue swelling and laterally under the acromion for tendon insertion tenderness.

b. Function of the entire shoulder complex is evaluated by elevating both arms from 0 degrees along the sides of body to 180 degrees straight above the head. Quantify internal rotation by having the patient reach with the dorsum of the hands the highest possible level of the back ( Fig 1-2); quantify external rotation by noting the position behind the neck or head that the hands can reach.

Posterior Vertebral Rotation

FIG. 1-2. Internal rotation of shoulder, posterior view. Record range of reach: Dorsum of hand to specific vertebral bodies.

c. Isolate the glenohumeral joint motion from the scapulothoracic motion by fixing the scapula. Holding both hands, assist the patient in abducting arms to the normal maximum of 90 degrees, and note restriction of motion on either side. To determine internal and external rotation of the glenohumeral joint on each side, the examiner places one hand on the shoulder to prevent scapular motion and, with the other hand, assists each arm to full external rotation of 90 degrees and full internal rotation of 80 degrees ( Fig 1-3).

Shoulder Rotation Degrees
FIG. 1-3. Shoulder rotation (with arm in abduction).

Was this article helpful?

0 0

Post a comment