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69 Radiographic evaluation of the shoulder - what is important what is not
65
WORKSHOP Clinical evaluation of the shoulder. Whats new, what works and what does not. G. Murrell1* 1 St George Hospital
The aim of this workshop is to present data from a series of investigations evaluating which clinical tests are of value when assessing disorders of the shoulder, and to synthesise this data with practical demonstrations so that the practitioner may quickly and accurately make a diagnosis in a patient presenting with a disorder of the shoulder. All participants will receive a hard-copy handout of the symposium and a DVD demonstrating the clinical tests referred to in the symposium.
Clinical tests for rotator cuff pathology and their predictive value
66
J. Walton1* & G. Murrell1 1 St George Hospital
Rotator cuff tears account for almost 50% of major shoulder problems but are often difficult to diagnose. To aid diagnosis, we carried out a prospective study, comparing the results of 23 clinical tests from 400 patients with and without rotator cuff tears. Three simple tests were predictive for rotator cuff tear: (1) supraspinatus weakness, (2) weakness in external rotation and (3) impingement. When all were positive, or if two tests were positive and the patient was over 60, the patient had a 98% chance of having a rotator cuff tear; combined absence of these features excluded this diagnosis.
Clinical tests for shoulder instability, including SLAP and GLEN lesions
67
J. Paoloni1* 1 Premier Orthopaedics
We have conducted a series of clinical investigations to determine which tests are most useful for diagnosing shoulder instability and labral pathology including SLAP (superior labrum anterior to posterior) tears and GLEN (glenoid labrum cyst entrapping the inferior branch of the suprascapular nerve) lesions. For anterior instability, the apprehension sign and its variants – the augmentation and relocation signs, are the most reliable tests for anterior instability when using apprehension rather than pain as the diagnostic criteria. The O’Brien’s sign is a useful sign for SLAP lesions, however acromio-clavicular (A-C) joint pathology needs to be excluded with AC joint tests before relying on the O’Brien sign. A GLEN lesion can be identified when the ratio of external rotation power/internal rotation power – as assessed using a held dynamometer – is less than 0.5.
Practical demonstration of a complete shoulder examination
68
G. Murrell1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
We will demonstrate a complete shoulder examination on a live subject. This will include examinations of the neck, and tests for the AC joint, biceps pathology, adhesive capsulitis, glenohumeral joint arthritis, rotator cuff tears – subscapularis, supraspinatus and infraspinatus, impingement, SLAP lesions, GLEN lesions, shoulder laxity, anterior and posterior instability.
Radiographic evaluation of the shoulder - what is important what is not
69
B. Andres1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
Plain radiographs of the shoulder are important for diagnosing a number of conditions of the shoulder. These include calcific tendonitis, osteoarthrtitis, fractures, and cuff tear arthropathy.
Ultrasound of the shoulder
70
L. Briggs1* & R. Tantau1,2* 1 Premier Ultrasound, St George Hospital Campus 2 St Vincents Hospital
Two experienced musculoskeletal ultrasonographers will perform live demonstrations of subjects with shoulder pathology to illustrate the abilities and limitations of ultrasound in assessing a painful glenohumeral joint.
Practical demonstration - making a diagnosis in 45 seconds
71
G. Murrell1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
We have performed a number of investigations to determine which of the myriad of tests are useful for diagnosing disorders of the shoulder. Information from these investigations has allowed us to eliminate a number of less useful tests, so that the clinician can make a presumptive diagnosis of a shoulder disorder in 45 seconds or less. The steps involved include: S-C and A-C joint palpation, the Paxinos test, passive external rotation, strength in external rotation and supraspinatus, impingment signs, 36 O’Brien’s sign, and if appropriate apprehension, augmentation and relocation signs. This examination sequence will be demonstrated in a live subject, and a DVD illustrating these tests as well as a complete shoulder examination will be available to participants of the seminar.
WORKSHOP Clinical evaluation of the shoulder. Whats new, what works and what does not. G. Murrell1* 1 St George Hospital
The aim of this workshop is to present data from a series of investigations evaluating which clinical tests are of value when assessing disorders of the shoulder, and to synthesise this data with practical demonstrations so that the practitioner may quickly and accurately make a diagnosis in a patient presenting with a disorder of the shoulder. All participants will receive a hard-copy handout of the symposium and a DVD demonstrating the clinical tests referred to in the symposium.
Clinical tests for rotator cuff pathology and their predictive value
66
J. Walton1* & G. Murrell1 1 St George Hospital
Rotator cuff tears account for almost 50% of major shoulder problems but are often difficult to diagnose. To aid diagnosis, we carried out a prospective study, comparing the results of 23 clinical tests from 400 patients with and without rotator cuff tears. Three simple tests were predictive for rotator cuff tear: (1) supraspinatus weakness, (2) weakness in external rotation and (3) impingement. When all were positive, or if two tests were positive and the patient was over 60, the patient had a 98% chance of having a rotator cuff tear; combined absence of these features excluded this diagnosis.
Clinical tests for shoulder instability, including SLAP and GLEN lesions
67
J. Paoloni1* 1 Premier Orthopaedics
We have conducted a series of clinical investigations to determine which tests are most useful for diagnosing shoulder instability and labral pathology including SLAP (superior labrum anterior to posterior) tears and GLEN (glenoid labrum cyst entrapping the inferior branch of the suprascapular nerve) lesions. For anterior instability, the apprehension sign and its variants – the augmentation and relocation signs, are the most reliable tests for anterior instability when using apprehension rather than pain as the diagnostic criteria. The O’Brien’s sign is a useful sign for SLAP lesions, however acromio-clavicular (A-C) joint pathology needs to be excluded with AC joint tests before relying on the O’Brien sign. A GLEN lesion can be identified when the ratio of external rotation power/internal rotation power – as assessed using a held dynamometer – is less than 0.5.
Practical demonstration of a complete shoulder examination
68
G. Murrell1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
We will demonstrate a complete shoulder examination on a live subject. This will include examinations of the neck, and tests for the AC joint, biceps pathology, adhesive capsulitis, glenohumeral joint arthritis, rotator cuff tears – subscapularis, supraspinatus and infraspinatus, impingement, SLAP lesions, GLEN lesions, shoulder laxity, anterior and posterior instability.
Radiographic evaluation of the shoulder - what is important what is not
69
B. Andres1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
Plain radiographs of the shoulder are important for diagnosing a number of conditions of the shoulder. These include calcific tendonitis, osteoarthrtitis, fractures, and cuff tear arthropathy.
Ultrasound of the shoulder
70
L. Briggs1* & R. Tantau1,2* 1 Premier Ultrasound, St George Hospital Campus 2 St Vincents Hospital
Two experienced musculoskeletal ultrasonographers will perform live demonstrations of subjects with shoulder pathology to illustrate the abilities and limitations of ultrasound in assessing a painful glenohumeral joint.
Practical demonstration - making a diagnosis in 45 seconds
71
G. Murrell1* 1 Sports Medicine and Shoulder Service, St George Hospital Campus
We have performed a number of investigations to determine which of the myriad of tests are useful for diagnosing disorders of the shoulder. Information from these investigations has allowed us to eliminate a number of less useful tests, so that the clinician can make a presumptive diagnosis of a shoulder disorder in 45 seconds or less. The steps involved include: S-C and A-C joint palpation, the Paxinos test, passive external rotation, strength in external rotation and supraspinatus, impingment signs, 36 O’Brien’s sign, and if appropriate apprehension, augmentation and relocation signs. This examination sequence will be demonstrated in a live subject, and a DVD illustrating these tests as well as a complete shoulder examination will be available to participants of the seminar.