thick description look over the shoulder

The Jobe sign is performed by having the patient’s arm abducted 90 degrees in the scapular plane and fully internally rotated (thumbs down). Several provocative tests and physical examination maneuvers have been described to evaluate the rotator cuff.

The presence of concomitant shoulder stiffness as marked by diminished active and passive ROM should be identified and treated prior to RTC surgery in order to minimize the chances for postoperative range of motion difficulty. Patients with pain and/or weakness secondary to supraspinatus muscle/tendon dysfunction may display a “painful arc” during shoulder abduction, as well as a “drop arm” sign in which the arm collapses to the side from a position of abduction. Both active and passive forward flexion, internal and external rotation of each shoulder is recorded. A systematic assessment of shoulder range of motion (ROM) is then performed. As with any general examination, previous surgical scars and the presence of any skin lesions should also be noted.Īfter inspection, palpating the bony prominences including the AC joint, greater tuberosity, acromion, and bicipital groove should be carried out in an attempt to elicit tenderness and potential sites of concomitant pathology. On occasion, swelling due to an enlarged bursa can be identified. Concomitant degenerative processes may occur with findings of an enlarged acromioclavicular (AC) joint.

For this reason, both shoulders should be inspected for comparison and symmetry. In the case of chronic tears, inspection may reveal muscle atrophy within the supraspinatus and infraspinatus fossae. Diagnostic Workupĭiagnostic workup begins with a history and physical examination. Previous relevant surgical history, the presence of medical comorbidities, tobacco use and a general review of systems to assess candidacy for future surgical management should also be included. Of note, the presence of pain and weakness for more than a year in the setting of a history consistent with full-thickness RTC tear, has also been reported to be associated with a worse prognosis. Often, patients may also mention difficulty with reaching for objects on high shelves or pain with other overhead activities such as combing their hair or reaching for objects in their back pocket. They may or may not have had previous surgeries or interventions on the shoulder.

Patients presenting with a full-thickness RTC tear typically complain of an achy-type pain that radiates laterally down the side of the shoulder, usually remaining above the elbow, often worse at night.

Thick description look over the shoulder