Table Of Content

Clinical and Radiological Examination of the Shoulder Joint A Guide for Advanced Practice Physiotherapists Helen Razmjou Monique Christakis 123 Clinical and Radiological Examination of the Shoulder Joint Helen Razmjou • Monique Christakis Clinical and Radiological Examination of the Shoulder Joint A Guide for Advanced Practice Physiotherapists Helen Razmjou Monique Christakis Sunnybrook Health Sciences Centre Department of Medical Imaging Toronto, ON, Canada Sunnybrook Health Sciences Centre Toronto, ON, Canada Department of Physical Therapy University of Toronto Toronto, ON, Canada ISBN 978-3-031-10469-5 ISBN 978-3-031-10470-1 (eBook) https://doi.org/10.1007/978-3-031-10470-1 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to the children of the world with the hope that one day, every child will enjoy the right to education, health care, and pursuing their dreams. All proceeds of this book’s sale will be dedicated to improving the lives of forgotten children who do not get to experience the joy of childhood as they grow up in poverty, illness, war, or injustice. Acknowledgments Significance of each scientific discovery, particularly in the field of medicine, is better appreciated when contribution of the former medical scholars is weighed in light of limited diagnostic tools they had access to. By providing an insight into the history of common shoulder conditions, we acknowledge the hardship and contribution of each scholar who originated the voyage we are on today. Inspiration of our mentors and colleagues, whose love of humanity made them better practitioners in medicine, is acknowledged. All illustrations are drawn by Madineh Azizy, a talented 16-year-old girl with an autoimmune deficiency illness. vii Contents 1 Diagnostic Clinical Decision-Making in Shoulder Pathology . . . . . . . 1 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Definition of Diagnostic Indices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Origin of Shoulder Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Nociceptive Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Neuropathic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Cervical Spine-Related Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Non-spinal Neuropathic Shoulder Pain . . . . . . . . . . . . . . . . . . . . . . . 6 Major Categories of Common Shoulder Pathology . . . . . . . . . . . . . . . . 9 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2 Impingement Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Primary or Outlet Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Intrinsic Factors of Primary Impingement Syndrome . . . . . . . . . . . . 14 Calcified (Calcifying) Tendinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Extrinsic Factors of Primary Impingement Syndrome . . . . . . . . . . . . 16 Acromion Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Subacromial Osseous Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Acromioclavicular Joint (AC) Pathologies . . . . . . . . . . . . . . . . . . . . . . . 18 Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Os Acromiale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Osteolysis of the Distal Clavicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Coracoacromial Ligament (CAL) Pathology . . . . . . . . . . . . . . . . . . . 20 Coracoid Impingement Syndrome (CIS) . . . . . . . . . . . . . . . . . . . . . . 21 Clinical Findings of Primary Impingement Syndrome . . . . . . . . . . . . 21 Internal Impingement Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Clinical Findings and Management of Internal Impingement Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Secondary and Functional Impingement Syndrome . . . . . . . . . . . . . . . . 24 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 ix x Contents 3 Biceps Brachii Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Proximal Long Head of Biceps Brachii Pathology . . . . . . . . . . . . . . . . . 33 Clinical Findings and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Proximal Short Head of Biceps Brachii Pathology . . . . . . . . . . . . . . . . . 35 Clinical Findings and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Distal Biceps Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Clinical Findings and Management . . . . . . . . . . . . . . . . . . . . . . . . . . 36 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4 Tears of Rotator Cuff Tendons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 42 Types of Rotator Cuff Tears (Partial Vs. Full Thickness) . . . . . . . . . . . . 43 Importance of Cuff Tear Location and Involvement of Rotator Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Natural History of Rotator Cuff Disease . . . . . . . . . . . . . . . . . . . . . . . . . 46 Clinical Findings of Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . 47 Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Management of Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Partial-Thickness Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . 52 Full-Thickness Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Historical Landmarks and Surgical Decision-Making . . . . . . . . . . . . 53 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 5 Cuff Tear Arthropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 61 Prevalence of CTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Clinical Findings of Cuff Tear Arthropathy . . . . . . . . . . . . . . . . . . . . . . 64 Range of Motion Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Pseudoparalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Strength-Related Clinical Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Imaging Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Management of Cuff Tear Arthropathy . . . . . . . . . . . . . . . . . . . . . . . . . . 67 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 6 Frozen Shoulder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 76 Incidence and Risk Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Clinical Findings and Role of Capsular Pattern of Restriction . . . . . . . . 78 Differential Diagnosis for Frozen Shoulder . . . . . . . . . . . . . . . . . . . . . . 79 Conservative and Surgical Management . . . . . . . . . . . . . . . . . . . . . . . . . 80 Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) and Oral Corticosteroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Contents xi Rehabilitation and Manual Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Corticosteroid Injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Distension Arthrography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Closed Manipulation under Anesthesia . . . . . . . . . . . . . . . . . . . . . . . 82 Surgical Release of Capsule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7 Arthritis of the Glenohumeral Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 92 Rheumatoid Arthritis of Glenohumeral Joint . . . . . . . . . . . . . . . . . . . . . 94 Capsulorrhaphy Arthropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Avascular Necrosis or Osteonecrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Septic Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Neuropathic Arthropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Rare Genetic and Hereditary-Induced Arthritis . . . . . . . . . . . . . . . . . . . 98 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8 Superior Labral Anterior and Posterior Lesions . . . . . . . . . . . . . . . . . 103 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 104 Clinical Findings of SLAP Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 9 Glenohumeral Joint Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Characteristics, Classification, and Causes . . . . . . . . . . . . . . . . . . . . . . . 113 Anterior Glenohumeral Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Posterior Glenohumeral Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Inferior Glenohumeral Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Multidirectional Hypermobility (Laxity) . . . . . . . . . . . . . . . . . . . . . . 116 Rare Hereditary Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Clinical Findings of Glenohumeral Joint Instability . . . . . . . . . . . . . . . . 117 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10 Principles of Radiological Examination . . . . . . . . . . . . . . . . . . . . . . . . 125 Conventional Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Standard Anteroposterior (AP) View . . . . . . . . . . . . . . . . . . . . . . . . . 126 True Anteroposterior (Grashey) View . . . . . . . . . . . . . . . . . . . . . . . . . 127 Supraspinatus Outlet View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Scapular Outlet “Y” View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Acromioclavicular (Zanca) View . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Axillary Lateral View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Stryker Notch View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 West Point View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 xii Contents Other Diagnostic Imaging Modalities of the Shoulder Joint . . . . . . . . . 134 Ultrasonography (US) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Magnetic Resonance Imaging (MRI) without Contrast . . . . . . . . . . . 135 Magnetic Resonance Arthrography (MRA) . . . . . . . . . . . . . . . . . . . . 136 Computed Tomography (CT) Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Disadvantages, Precautions, and Contraindications . . . . . . . . . . . . . . . . 136 Conventional Radiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Ultrasonography (US) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Magnetic Resonance Imaging (MRI) without Contrast . . . . . . . . . . . 137 Magnetic Resonance Arthrography (MRA) . . . . . . . . . . . . . . . . . . . . 138 Computed Tomography (CT) Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 11 Radiographic Features of Rotator Cuff and Biceps Tendon Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Subacromial Impingement Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Inferior Cortical Acromial Sclerosis (Sourcil Sign) . . . . . . . . . . . . . . 141 Subacromial Spurs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Subacromial Enthesophytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Subacromial Osteophytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Greater Tuberosity Cortical Irregularity . . . . . . . . . . . . . . . . . . . . . . . 144 Calcified Tendinitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Acromion Morphology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Acromioclavicular Joint Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . 148 Chondrocalcinosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Geyser Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Osteolysis of the Distal Clavicle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Acromioclavicular Joint Separation . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Os Acromiale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Biceps Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Proximal Biceps Tendon Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Distal Biceps Tendon Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Partial- and Full-Thickness Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . 154 Inferior Cortical Acromial Sclerosis (Sourcil Sign) . . . . . . . . . . . . . . 155 Greater Tuberosity Cortical Irregularity . . . . . . . . . . . . . . . . . . . . . . . 156 Humeral Head Cysts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Subacromial Enthesophytes and Osteophytes . . . . . . . . . . . . . . . . . . 157 Superior Migration of the Humeral Head in Relation to the Glenoid . 157 Critical Shoulder Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Other Imaging Modes of Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . 159 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

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