By Bruce Carl Anderson, MD
This new better half to place of work Orthopedics for fundamental Care, third version, presents undemanding, in-depth, full-color counsel at the analysis of fifty two of the most typical musculoskeletal difficulties noticeable in trendy medical settings. It spells out precisely what to seem for through the actual exam and in what series, delivering readers with the data they should successfully diagnose those difficulties. Lavish, full-color photos and line drawings increase the textual content and make techniques more straightforward to understand.Features the services of Dr. Bruce Carl Anderson, a global authority on orthopedic perform in fundamental care.Presents confirmed "how-to's" of analysis for the fifty two commonest orthopedic problems.Features certain descriptions and extravagant illustrations-with 1000's of colour photographs-to express each point of right diagnosis.Provides accomplished remedy reference tables that record best-practice remedies, tactics, and gear, corresponding to helps, braces, and casts.Gives cross-references to the significant other quantity, place of work Orthopedics for fundamental Care, third Edition.Includes many at-a-glance tables exhibiting diagnostic assistance and contours, scientific pearls, and differential diagnoses.
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Additional resources for Office orthopedics for primary care: diagnosis issue orthopedics, general practice
Downward movement of the humeral head is restricted by the tone and bulk of the deltoid, the tone and thickness of the supraspinatus tendon, and the redundancy of the glenohumeral capsule. This maneuver is used to assess the looseness of the shoulder joint, the subacromial space (subluxation), and the patient’s potential tolerance of the pendulum stretch exercise. MANEUVER: The patient is asked to relax the shoulder. One hand is placed atop the acromion, and one hand is placed in the antecubital fossa.
FIGURE 2–40. Shoulder pain referred from the pleura and lung. SHOULDER 2–1 45 DETAILED EXAMINATION SUMMARY EXAMINATION MANEUVERS DIAGNOSIS CONFIRMATION PROCEDURES Isometrically performed resisted midarc abduction or external rotation 1. Rotator cuff tendonitis Local anesthetic placed in the subacromial bursa; no signiﬁcant muscle weakness 2. Impingement syndrome Local anesthetic placed in the subacromial bursa Rotator cuff tendonitis with tear Local anesthetic placed in the subacromial bursa with persistent muscle weakness Frozen shoulder Local anesthetic placed in the subacromial bursa with persistent loss of range of motion The passively performed painful arc maneuver Local subacromial tenderness The passively performed painful arc maneuver Local subacromial tenderness Weakness of midarc abduction or external rotation Isometrically performed resisted midarc abduction or external rotation The passively performed painful arc maneuver Local subacromial tenderness Loss of external rotation or abduction with endpoint stiffness Abnormal Apley scratch sign No radiographic evidence of glenohumeral arthritis Inability to reach overhead Loss of external rotation or abduction with endpoint stiffness Glenohumeral osteoarthritis Radiographic evidence of glenohumeral arthritis Bicipital tendonitis Local anesthetic placed in the bicipital groove Rupture of the long head of the biceps Examination Multidirectional instability of the shoulder (subluxation) Examination AC joint arthritis Shoulder series x-ray Local tenderness at the AC joint AC joint injury Weighted views of the shoulder or local anesthetic placed over the AC joint Pain aggravated by passive adduction 1st-degree separation AC joint opens with traction applied at the elbow 2nd-degree separation AC joint deformity: the clavicle is elevated above the acromion 3rd-degree separation Local tenderness at the SC joint SC joint arthritis Apical lordotic views of the chest, local anesthetic placed over the SC joint Subscapular bursitis Local anesthetic placed over the adjacent 2nd or 3rd rib Abnormal Apley scratch sign Inability to reach overhead Bicipital groove tenderness Pain aggravated by resisted elbow ﬂexion “Popeye” deformity in the antecubital fossa Pain aggravated by resisted elbow ﬂexion Inability to reach overhead ϩSulcus sign with downward traction applied at the elbow Abnormal anteroposterior movement of the humerus (translation) Apprehension with passive rotation of the shoulder Bony enlargement of the AC joint Local tenderness at the AC joint Pain aggravated by passive adduction Pseudoenlargement of the clavicle Tenderness under the superior medial angle of the scapula No tenderness of the rhomboid or levator scapula muscles 46 OFFICE ORTHOPEDICS FOR PRIMARY CARE: DIAGNOSIS COMMON SHOULDER FRACTURES SUMMARY Fractures of the shoulder are not common, and those that do occur are seen in very speciﬁc age groups.
SURGICAL REFERRAL: Surgery must be considered in the case of any fracture associated with ﬁrst rib, pneumothorax, or neurovascular injury (less than 3%); in distal third fractures with displacement (because of the greater risk of nonunion); and in poorly healing fractures that are complicated by shoulder dysfunction or chronic pain. PROGNOSIS: Complications include dislocation of the AC or SC joint; head and neck injuries (displaced fractures); ﬁrst rib fracture; pneumothorax (3%); brachial plexus injury (caused by severe and forceful blows in a downward direction); subclavian vessel or internal jugular vein injuries (caused by rare, severe blows); nonunion, which is rare; and malunion with cosmetic deformity, which is common.