Shoulder Anatomy and Joint Examination

Joint Inflammation and Assessment

• Increased warmth observed in conditions like arthritis, tendinitis, bursitis, and osteomyelitis.
• Redness overlying skin is least common in infections of deeper joints, typically seen in superficial joints such as fingers, toes, and knees.
• Diffuse tenderness and warmth hint at arthritis or infection, while focal tenderness suggests injury or trauma.
• Key anatomical identification crucial when assessing pain or tenderness in joints, with redness indicating acute inflammation possibly from septic, crystalline, or rheumatoid arthritis.

Temporal Mandibular Joint (TMJ) Examination

• Assess TMJ by inspecting the face and joint, followed by palpation of the TMJ and muscles involved in mastication.
• Evaluate jaw range of motion: opening, closing, protrusion, retraction, and lateral movements.

Shoulder Examination

• Inspect the shoulder anteriorly and scapulae posteriorly and palpate major joint structures: sternoclavicular joint, clavicle, acromioclavicular joint, greater tubercle, and underlying muscles.
• Assess range of motion through flexion, extension, abduction, adduction, and internal/external rotations.
• Conduct special tests if indicated, such as painful arc test, Neer test, Hawkins test, and drop arm test for shoulder pathology.
• Pay attention to muscle atrophy signs that may indicate scapular winging.

Elbow Examination

• Inspect and palpate the elbow's contours and the extensor surfaces of the ulna.
• Olecranon process may indicate bursitis or traumatic dislocation.
• Check tenderness around medial and lateral epicondyles related to conditions like tennis or pitcher’s elbow.
• Range of motion assessment includes flexion, extension, pronation, and supination, with consideration for special tests like Cozen's test to diagnose epicondylitis.

Red Flags for Low Back Pain

• Significant indicators for serious underlying conditions include age under 20 or over 50, cancer history, unexplained weight loss, fever, or a decline in general health.
• Persistent pain for over a month unresponsive to treatment, night pain, history of IV drug use, immunosuppression, and neurologic symptoms should trigger further investigation.

Mechanical Low Back Pain

• Characterized by aching pain in the lumbosacral area, potentially radiating along L5 or S1 dermatomes, typically acute and work-related, predominantly in those aged 30 to 50.
• Physical signs include tenderness, muscle spasm, and pain during back movement, with no loss of motor or sensory function.

Sciatica or Radicular Low Back Pain

• Often results from disc herniation or nerve root compression.
• Clinical signs may include calf wasting, weak ankle dorsiflexion, absent ankle reflex, and positive crossed straight leg raise test.

Lumbar Spinal Stenosis

• Characterized by pseudo claudication, pain improves with rest and lumbar flexion, generally bilateral with possible leg paresthesia, frequently due to arthritic narrowing.
• Physical signs include forward flexed posture, lower extremity weakness, and typically negative straight leg raise.

Chronic Back Issues and Related Conditions

• Consider ankylosing spondylitis in inflammatory polyarthritis, primarily affecting men under 40.
• Physical assessment may show loss of normal lumbar lordosis, muscle spasm, and limited motion, which often improves with exercise and is accompanied by nocturnal back pain, unrelieved by rest.
• Evaluate for metastatic disease signs through local vertebral tenderness and pain referral from the abdomen or pelvis.

Elbow Pain Specifics

• Lateral epicondylitis (tennis elbow) presents as pain and tenderness distal to the lateral epicondyle, with increased pain on wrist extension against resistance.
• Rheumatoid arthritis involves chronic inflammation of synovial membranes, leading to cartilage erosion and joint damage.

Patterns of Spread and Symptoms

• Rheumatoid arthritis typically exhibits symmetrical and additive spread across joints, with hands, feet, and knees being common sites.
• Symptoms often include swelling of joints or tendon sheaths, coupled with tender, warm joints that rarely exhibit redness.

Wrist and Hands Examination

• Inspect wrist, hand, and finger bones along with thenar and hypothenar eminences.
• Guarded movements indicate injury; observe for asymmetry in DIP and PIP deformities in osteoarthritis (OA).
• Symmetric deformities evident in PIP, MCP, and wrist joints in rheumatoid arthritis (RA).
• Palpate structures: radius, ulna, radial styloid, and anatomical snuffbox, along with flexor tendons, carpal bones, and metacarpals.
• Swelling, tenderness, and signs of rheumatoid arthritis, including ganglia and gonococcal infection, are critical.
• Tenderness over the ulnar styloid suggests Colles' fracture; tenderness in the anatomical snuffbox indicates scaphoid fracture.
• Assess range of motion: flexion, extension, abduction, and adduction for wrist and fingers; include thumb opposition.
• Special tests for grip strength, Finkelstein's test for thumb tenosynovitis, and Tinel’s/Phalen’s signs to assess median nerve entrapment.

Spine Examination

• Inspect posture and the cervical, thoracic, and lumbar spine curves laterally.
• Evaluate shoulder alignment, iliac crest, and gluteal folds for abnormalities like kyphosis, scoliosis, or lordosis.
• Palpate spinal processes and paravertebral muscles for tenderness, trauma, or infection.
• Assess range of motion in cervical and thoracolumbar spine: flexion, extension, rotation, and lateral bending.
• Special maneuvers, such as Spurling's test, indicate cervical radiculopathy or decreased mobility in arthritis.

Hip Joint Examination

• Inspect gait and lumbar spine alongside anterior and posterior hip structures.
• Problems likely manifest during weight-bearing stance; normal width of base is two to four inches heel-to-heel.
• Identify impaired pelvic shift in arthritis or hip dislocation, and weakness affecting gait.
• Palpate anterior landmarks: iliac crest, tubercle, anterior superior iliac spine, greater trochanters, and pubic tubercle.
• Palpate posterior landmarks: posterior superior iliac spine, ischial tuberosity, and sacroiliac joint.
• Assess for inguinal hernia or aneurysms through palpation of the inguinal ligament.
• Special tests like the anterior and posterior drawer test evaluate ACL and PCL stability, respectively.

Knee Examination

• Evaluate for effusions using bulge, balloon, and ballotment signs to detect fluid in the joint.
• ACL tears indicated by a positive anterior drawer sign or Lachman test; PCL tears by a positive posterior drawer sign.
• Test for swelling through manipulation of the suprapatellar pouch; assess patellar movement for fluid accumulation.

Red Flags in Low Back Pain

• Patients under 20 or over 50 years old, history of cancer, unexplained weight loss, or fever warrant caution.
• Persistent pain lasting over one month, especially at night or at rest, is concerning.
• Consider IV drug use, immunosuppression, infections, and neurological symptoms as potential serious underlying conditions.
• Physical exam reveals mechanical back pain characterized by aching in the lumbosacral area, often related to work stress with no underlying pathology.
• Check for perispinal muscle tenderness, spasms, and loss of normal lumbar lordosis without motor or sensory deficits.

Test your knowledge on the anatomical structures and assessment techniques involved in shoulder examinations. This quiz covers range of motion, signs of inflammation, and palpation techniques relevant to shoulder assessments. Understand what to look for during a clinical evaluation of the shoulder joint.