图解肩袖检查

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1、ExaminationoftherotatorcuffSJDrewandRJEmery Figure1:Palpationofthebulkoftheinfraspinatusmuscle.Figure2: Palpationforadefectinthesuperioraspectoftherotatorcuff.Figure3: Thelift-offtestofGerber,withtheadditionoftheapplicationofresistance.  Figure4: Demonstrationofapositiveinternal

2、rotationlagsignwherethepatientisunabletoactivelymaintainthehandheldbackwardsofftheback.Figure5: Thebellypresstest.Thepatientisunabletopreventthehumerusandelbowfallingbackintoextensionbecauseofasubscapularistear.Figure6: Aninabilitytoresisttheexaminersdownwardpressurebecauseofate

3、arofthesupraspinatus. Figure7: Aninabilitytoresistaninternalrotationforcebecauseofatearoftheposteriorcuff(infraspinatusandteresminor). Figures 8&9:Thepatientsarmispassivelytakenintomaximalexternalrotation(figure8)andaskedtomaintainthispositionwhentheexaminerletsgoofthearm.Aninab

4、ilitytomaintainthispositionsothatthearmswingsbacktowardstheneutralpositiondemonstratesapositiveexternalrotationlagsign(figure9).Figure10: Apositivehornblowerssignontheright.WhilsttheexpansionandimprovementinimagingtechniquesmostnotablyultrasoundandMRIhasundoubtedlyimprovedourund

5、erstandingofrotatorcuffpathologythemanagementofrotatorcufftearscanbebasedalmostentirelyonclinicalfindings.Theaimsoftheclinicalexaminationespeciallywhenoneisconsideringoperativeinterventionaretodetermine:1)Thattheshoulderisnotstiff2)Thesourceofthepain.Thismayarisefromavarietyofso

6、urcesincluding;Subacromialinflammation/bursitis,mechanicalimpingement,fatigue(painexperiencedonactivityfromaweakeasilyfatiguedmuscle)andintrinsiccuffpathology.3)Thesiteoftherotatorcufftear.Itisparticularlyimportanttodetermineifthereisasubscapularistearsincethiswouldnotbeeasilyac

7、cessibleviaastandardapproachusedforcuffsurgerysuchasadeltoidsplit.4) Thesizeoftherotatorcufftear.Ifthetearisverylargeasdemonstratedaswillbediscussedlaterbythepresenceoflagsigns,thenitmaynotbepossibletosurgicallyrepairthetear.AmuscletransfersuchasaLatissimusdorsitransfershouldbec

8、onsideredinthesesituationsinwhichcasethepatient