Question

What is the organized physical examination that follows the orthopedic examination outline?

6. A physically fit 55 year old right hand dominant female presents to the clinic for evaluation of right anterior shoulder pain off and on for the last month. She works out at the gym and has noticed pain when lifting weights. She notes pain, that is sometimes sharp, when she does bicep curls or raises the weights forward to shoulder height. She notes no popping sensations. She has tried heat, ice and medications with no relief. She presents today because she has noticed a little swelling and the pain is radiating into her bicep area. Resting it for a couple of days has only helped minimally. She denies any significant past medical history.

Answer 1

Answer :

Before doing physical examination, We need to wash our hands , introduce ourself ,conform patient details and explain the procedure before doing the physical examination .

Physical examination contain mainly four assessments

• Inspection
• Palpation.
• Percussion
• Auscultation .

Expose patient's upper body appropriately

Position the patient standing .

Inspect the patient :

Anterior :

Scars : previous surgery / trauma.

Asymmetry of the shoulder girdle : scoliosis , arthritis , trauma - clavicular fracture / humeral fracture / anterior dislocation of humeral head .

Swelling : inflammatory joint disease / effusion / anterior dislocation .

Muscle wasting : deltoids _axillary nerve injury

LATERAL :

Scars , asymmetry .

Assess muscle bulk of trpezius and deltoids - symmetry , wasting .

Para vertebral muscles : note any swelling / wasting .

FEEL :

assess temperature of shoulder - warmth may suggest inflammation / infection.

Palpate the various components of shoulder girdle : sterno cervical joint , clavicle , acromio- clavicular joint , coracoid process .

Medial to clavicular tip : head of humerous , greater tuberosity of humerous , spine of scapula .

MOVE :

External and internal rotation .

Full shoulder examination : flexion ,extension, abduction , adduction , external rotation , internal rotation

Assess the movement of scapula :

• Ask the patient to abduct their shoulder
• Simultaneously palpate the inferior pole of the scapula .
• On average 50- 70% of the first movement occurs at the glenohumeral joint .

PASDIVE MOVEMENTS :

ask the patient to fully relax and allow you to move their arn them.

Warn them that should they experience any pain they should let you know immediately .

Repeat the above movement passively - feel For crepitus during movement of the joint .

In above question :

The 55 years female complaining about right anterior shoulder pain

The pain may be due to sprain in the right shoulder because she doing workouts in a gym .

By doing weight lifting ,she may got the sprain in the anteior shoulder so she is getting pain when weight lifting and swelling and all .

Investigations like x _ ray will be needed to know the exact diagnosis such as dislocations or sprains etc.