Examination of Pediatric Shoulder
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
This chapter deals with the examination of the shoulder joint in children and adolescents. It defines the diagnostic test involved for shoulder instability and cuff pathologies with a special focus on the pediatric population. Shoulder injuries are common and account for up to 10% of all sports injuries in high school athletes. The glenohumeral joint is a ball and socket joint that depends on the muscles and ligaments rather than its bony architecture for its support, stability, and integrity. A good clinical history, coupled with a systematic shoulder examination, helps to pinpoint the diagnosis. The cervical spine should be evaluated as part of the overall shoulder problem because cervical pathologies and thoracic outlet syndrome can have radiating pain in the shoulder. A patient with an anterior dislocation supports his/her arm away from the body with corresponding flattening of the deltoid contour, more common in children.
Surface Anatomy
Sarah Armstrong, Barry Clifton, Lionel Davis in Primary FRCA in a Box, 2019
This chapter explains that axilla is the area underlying the glenohumeral joint at the junction of the upper limb and thorax. Its overall shape is that of a four-sided pyramid with a base and an opening at the apex. The axillary vein drains the arm via the cephalic and basilic veins. The abdominal wall has five paired muscles. The external oblique originates from the inferior eight ribs. The internal oblique arises from the iliac crest, inguinal ligament and thoracolumbar fascia. Transversus abdominis is the deepest originating from the inguinal ligament, iliac crest, lower six ribs and thoracolumbar fascia. The vertical muscles within the rectus sheath separated by the linea alba – rectus abdominis and pyramidalis.
Case 45: My shoulder popped out
Eamon Shamil, Praful Ravi, Dipak Mistry in 100 Cases in Emergency Medicine and Critical Care, 2018
This chapter presents a case study of a 21-year-old man who arrived at the Emergency Department with his friend, bent over, holding the injured right arm flexed at the elbow and supported with his left hand. This patient has an anterior dislocation of the shoulder. Dislocations of the glenohumeral joint occur when a large force is applied to the joint, tearing the stabilising joint capsule and the surrounding tissues. Anterior dislocation is easily confirmed on the radiograph, but posterior dislocations are sometimes missed due to the subtle signs on anteroposterior (AP) projection – there is a characteristic 'light bulb' appearance of the humeral head. If the patient requires additional analgesia or chooses sedation, the patient must be moved to the resuscitation room, and a practitioner trained in sedation using appropriate monitoring must carry out the sedation whilst a second clinician carries out the reduction.
A comparison of glenohumeral joint translation between young and older asymptomatic adults using ultrasonography: a secondary analysis
Published in Physiotherapy Theory and Practice, 2020
Sangeeta Rathi, Nicholas F. Taylor, Rodney A. Green
ABSTRACT Background: The rotator cuff muscles are subject to age-related changes, but the effect of aging on glenohumeral joint stability is poorly understood. Objectives: This study aimed to compare glenohumeral joint translation in asymptomatic young and older people. Methods: Twenty young (23.6 ± 5.3 years) and twenty older (66.5 ± 7.8 years) participants with no symptomatic shoulder pathology were recruited. Anterior and posterior glenohumeral joint translations were measured using real-time ultrasound in two positions: (1) shoulder neutral; and (2) shoulder at 90 degrees’ abduction and four testing conditions: (1) rest; (2) passive accessory motion testing (PAMT) force alone; (3) PAMT with isometric internal rotation contraction; and (4) PAMT with external rotation contraction. Results: In both groups, there were significant differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior PAMT force (p
Function of the supraspinatus muscle: Abduction of the humerus studied in cadavers
Published in Acta Orthopaedica Scandinavica, 1994
Nikolaus Wuelker, Wolfgang Plitz, Bernd Roetman, Carl J Wirth
We evaluated the function of the supraspinatus tendon with a dynamic shoulder model. Active glenohumeral joint motion was simulated in 10 cadaveric shoulder specimens with hydrodynamic cylinder forces at the deltoid muscle and at the rotator cuff. Computerized regulation initiated standardized cycles of glenohumeral joint motion, where the isolated effect of the supraspinatus muscle could be studied. The efficacy of the supraspinatus muscle on elevation of the glenohumeral joint was measured with an ultrasonic sensor system. Pressures underneath the coracoa-cromial vault were recorded with capacitive sensors, as an indicator of the impingement at the shoulder. Elimination of force of the supraspinatus muscle led to a 6 percent decrease in elevation of the glenohumeral joint. The deltoid muscle was able to reverse this loss of elevation by a force increase of one third of the lost supraspinatus force. If no force was applied to the supraspinatus muscle, average pressures underneath the coracoacromial vault decreased 8 percent. It was concluded that the supraspinatus produces less torque and more glenohumeral joint compression than the deltoid. However, the supraspinatus has no effect on depression of the humeral head during elevation. The clinical consequence of our observations is that operative closure of supraspinatus tendon defects is not mandatory.
Reliability of Inferior Glide Mobility Testing of the Glenohumeral Joint
Published in Journal of Manual & Manipulative Therapy, 2001
Arie J. van Duijn, Richard H. Jensen
The purpose of this study was to investigate intratester and intertester reliability for inferior glide mobility testing of the glenohumeral joint, a frequently used accessory motion test. Eighteen volunteers (21–55 years) were studied; 10 subjects had a history of shoulder dysfunction. Three experienced orthopedic physical therapists performed three blinded ratings and one non-blinded rating of inferior glide mobility for each subject's right glenohumeral joint using a 7 point rating scale. Intraclass correlation coefficients (ICCs) were calculated to evaluate intratester reliability using the blinded ratings and the intertester reliability using the non-blinded ratings. The ICCs (3,1) expressing intratester reliability were .88, .56, and .53. The ICC (2,1) expressing intertester reliability was .52. Intratester reliability of inferior glide mobility testing of the glenohumeral joint was moderate to good. Intertester reliability was moderate. Clinicians need to exercise caution when making treatment decisions based on inferior glide mobility testing.
Related Knowledge Centers
- Ball & Socket Joint
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