Male Muscle Percentage

examination of the shoulder rotator cuff

of http://www.dgrh.de/paschulter.html : (see pictures there)

third Examination of the shoulder

Text in italics represent optional facts is to be developed!

General

• examination performed on the stationary (inspection), the sitting (palpation) and the patient is lying (eg stability testing)
• pain causes may lie outside of the shoulder joint (Head 'sche zones). Internal diseases (myocardial infarction, cholecystitis, Pancost tumors, etc.) and changes in the cervical spine should be deferred.

3.1. Inspection

Analysis of gait, the movement of the arms in walking, from early conversations

• is the movement of the shoulder joint for the bundle? Be avoided certain movements?

suspicious movement patterns:

• preventing movements above the horizontal line: frozen shoulder
• Pain-related fix the arm on one side: Bursitis calcarea
• Spontaneous internal rotation in relaxed, free-arm hanging => Note to Rotatorenmannschettenruptur Skin: bruises , swelling, redness, blisters, scars (eg accident zoster, herpes, surgery)
• contours: balanced, or canceled
• shoulder stand: Geradstand or depression
• changes in the clavicles, Sternoclavicular and Acromiaclaviculargelenk (step formation, swelling, high clavicle)
• muscular atrophy in the area of the rotator cuff, possibly with shoulder elevation of
• biceps tendon rupture: distal muscle belly of the biceps, limited Forearm
• protrusion of the shoulder blade has damage to the N. long thoracic

3.2. Palpation

Palpable bony landmarks:

• medial and lateral clavicle acromion
• Proc. coracoid
• tuberculum majus et minus with bicipital groove
• spina scapulae inferior angle of the scapula
• medial scapular border
• stability in the SC joint: review of the mobility of the clavicle
• examination of the AC joint: by adduction of the arm at the elbow flexed
• palpation of the joint space: in elevation and extension
• keys of the long biceps tendon: between tub. minus and majus
• keys of the infraspinatus approach: the tub. majus
• keys of the supraspinatus tendon: the case of extension of the arm below the acromion
• keys of the subscapularis tendon: is in external rotation on tubercle minor

3.3. Examination of the function

function of individual muscles: supraspinatus

• : starts infraspinatus abduction
• M.: external rotation, adduction
• subscapularis: internal rotation and adduction
• deltoid muscle: abduction
• teres minor: external rotation, adduction
• M. biceps: caput longum: abduction, short head: adduction

standard values for the active and passive motion (Neutral-0 method):

• adduction / abduction: 20 - 40 ° - 0 - 180 °
• anteversion / retroversion: 150-170 ° - 0 - 40 °
• horizontal extension / flexion: 135 ° - 0 - 40-50 °
internal / external rotation in adduction
• : 95 ° - 0 - 40-60 °
• internal / external rotation in 90 ° abduction, 70 ° - 0 - 70 °

3.3.1. Examination of the active mobility

Only on the healthy, sick then on the page. In the movements of the shoulder joint to the shoulder blade can be fixed.

• nerve pinch: shows function of the supraspinatus muscle (especially in abduction to 70 ° and the deltoid muscle)
• apron Handle: touching the lower end of the opposite scapula down behind his back as the ability of the internal rotators and adductors (and the m. subscapularis)
• touching the fingertips of the head with extended elbow: Trial of the deltoid muscle)

A disorder of the shoulder movement in all functional areas can have a Omarthritis (shoulder joint arthritis).

loss of active abduction and external rotation: so-called pseudoparalysis, an indication of fresh rupture of the rotator cuff .

3.3.2. Examination of passive Agility

The examiner stands behind the patient, a hand leads the movement of the arm, the other hand controls the movement of the scapula and the humeral head. To relieve the rotator cuff, the movement of the arm can be tested by forward inclination of the upper body and swing.

An orientation, whether the pain emanating from the shoulder, provides no analysis by Cyriax. Both arms are actively moved over the ear line next to the ear. Passively to one side then the arm will be conducted at a fixed thoracic spine and 10 ° behind the ear line. When pain arises beyond Shoulder joint, this is possible without problems (Fig. 1).

3.3.3. Function tests

impingement tests (to impinge: bounce, shock)

Certain movements cause compression of structures or crushing of soft tissues a localized pain.

In abduction between 40 ° and 120 ° occur with extended elbow compression subacromial structures between acromion and humeral head (subacromial arc Painful, painful Arc). Typical of changes in the supraspinatus and the bursa subdeltoid. A Painful arc is in the last 30 ° of abduction indicated irritation at the AC joint.

• impingement test according to Neer: forced flexion and internal rotation, ie => subacromial impingement
• impingement test after Hawkins: the slightly bent elbow is raised by the examiner and by simultaneously lowering his hand a subacromial impingement caused

;

Rotatorenmannschetten tests

• drop-arm sign: The patient's arms holds active in 90 ° abduction against resistance or against gravity (Fig. 2)
• zero-degree abduction test: active abduction at 0 ° abduction against resistance => Check the starter function of the external rotators M.supraspinatus
• test: The examiner stands behind the patient's arms patients hang side in neutral position, the elbow is 90 ° forward flexion. The forearms should move actively against the resistance of the examiner in the vertical (Fig. 3).
• The audit of the infraspinatus and teres minor is done by external rotation against resistance in 90 ° abduction + 90 ° - Elle diffraction (Fig. 3)
• Signe of Naboth: pressure in the arm from acromion Humeruslängsachse => Rotatorenmannschettenaffektion
• Jobe test: Hold the arm to pressure from cranial at 90 ° 30 ° horizontal flexion + abduction + inward rotation (thumbs down) => off of the deltoid muscle: function of the supraspinatus tendon
• A lesion in the subscapularis is seen when an active lift not the hand grip from the apron to posterior against the resistance of the examiner is possible. (Lift-off test according to Gerber). The examiner can fix the shoulder of the opposite side.

AC joint tests

• acromioclavicular Painful arc: complaints only about 120 ', which remain undiminished in the final position at 180 ° (cause of pain in the AC joint)
• horizontal Painful arc (cross-body-action): Pain with passive Horizontalflektion

tests of the long biceps tendon

• Yergason test: supination against resistance
• speed test: pressure upward against resistance with extended, supinated arm in 90 ° Anterversion (Fig. 5)

examination of Klavikulargelenkes

more resistance tests

adduction against resistance => Mm. latissimus dorsi, pectoralis major, teres major and minor

3.4. Neurological examination and testing of muscle strength

muscle tests: Evaluation of the force in comparison:

• level 5 (100%) possible movement against maximum resistance
• level 4 (75%) motion even against strong resistance possible
• Level 3 (50%) movement against gravity possible
• stage 2 (25%) movement with the elimination of gravity possible
• Level 1 (10%) No movement is possible, only muscle contraction
• Level 0 No contraction

investigation of the sensitivity of the test reflexes

:

• Addson maneuver to exclude a plexus irritation (eg, hypertrophy of the anterior M.scalenus)

3.5. Infiltration Test

differentiation of subacromial impingement versus affection of the AC joint: injection of local anesthetics in the subacromial space

• pain in subacromial impingement
• further pain and tenderness over the AC joint with AC Gelenksaffektion
• pain after 2 . injection into the AC joint