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ShoulderExam
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''Exam'' Check CSpine ROM - lead with thumbs flexion, abduction, ER - active and passive (and resisted ER ?lag) Jobes test (arms out horizontal and push down - thumbs up then thumbs down) Scarf test (hand over other shoulder) - impingement Hawkins kennedy (flexed to shoulder height, flexed elbow up and down) ''Mx'' Rest, physio, exersize Xray is useful ??US never MRI in primary care Inject - choice of 3 - look for initial response - Subacromial space, glenohumeral joint and aCJ Surgery / Barbotage ''Impingement'' - bony, bursa, RC tendinopathy ....... middle age, insidious, pain at night, pain moving above shoulder height (but will go passively), normal ER (?dec ROM) - Mx - Xray, inject sub-acromial space (response to injection impt) ''Calcific tendonitis'' - same as impingement - Mx ?Barbotage via MSKI ''ACJ dysfunction'' - trauma or similar to impingement ''LHB pathology'' - if acute and painful - early refer as surgery by 12/52, if older, non-painful consider Xray to ensure no spur that can cause RC tear ''Rotator Cuff tear'' (simply - subscapularis anterior, supraspinatus superior from scapula, infraspinatus posterior from scapula) note infraspin wasting in particular, C5-6, older pt, weakness above shoulder height, pain at night, passive ROM usually normal but not active (try forward stoop (bend forwards to lift arm to "above" head)), resisted ER weakness - catastrophic tear ''Frozen shoulder'' - adhesive capsulitis - restriction of active and passive ROM (restricted arc, esp ER), 40-60yr old women, night pain, 2-3yr to resolve, Mx - inject GHJ when painful, physio in non-painful phase ''GHJ OA'' ''Dislocations'' - mainly anterior Remember - PMR - bilateral multiple joints May have neck and shoulder pathology Glenohumeral injection - from below posterior acromion and head for coracoid process
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