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ShoulderandSpine Year1OSCE overviewShoulder Anatomy 1. Sternoclavicular joint 2. Clavicle 3. Acromioclavicular joint 4. Humeral Head 5. Coracoid process 6. Deltoid 7. Spine of Scapula 8. Supraspinatus 9. Infraspinatus 10. TrapeziusExamination Introduction and consent- checks patient name and DOB, explain examination *remember to wash hands and PPE* *Marks for direct comparison of both sides throughout* *enquire about pain* General inspection: - Exposure: Ask patient to remove shirt if comfortable, usually vest underneath if female - Observe for slings, analgesia, prescription charts etc. - Observe from front, side and back: Body habitus, Scars, bruising, swelling, erythema, muscle wasting or abnormal contours, winged scapula Palpation: - Systematic - Mention pain again, ask to inform you if any pain and watch face throughout - Looking for signs of tenderness, Temperature or swelling - Sternoclavicular > clavicle > AC joint > acromion > spine of scapula > head of humerus > coracoid process > deltoid > supraspinatus > infraspinatus > trapeziusMove *directly comparing*  Active 1. Flexion (ROM 150-180) 2. Extension (ROM 40) 3. Abduction (ROM 180) 4. Adduction (ROM 30-40) 5. External rotation (ROM 30-40) 6. Adduction (ROM level of T4-T8)  Repeat for passive movements: ▪ check ROM, pain and crepitus ▪ When passively abducting arm stabilize the scapulaExtra tests: • Hands behind head and push elbows back as far as possible • Move thumbs up back as far as possible • Empty can test, painful arc, external/ internal rotation against resistance, scarf test Pathology:  Adhesive capsulitis (frozen shoulder): stiffness and pain with reduced ROM both active and passive  Axillary Nerve Palsy: usually caused by shoulder dislocation- loss of sensation over lateral deltoid and deltoid wasting  Shoulder impingement syndrome: Inflammation of rotator cuff tendons- pain, weakness and reduced ROM- ‘painful arc’ between 60-120 degree arcSpineAnatomyIntroduction and consent *pain *exposure General inspection: • Ask patient to walk across room and back- gait, ROM, leg length etc. • Anterior: Body habitus, scars, wasting of muscles, posture, asymmetry of shoulder girdle, pelvis tilt • Lateral: Cervical lordosis, thoracic kyphosis and lumbar lordosis • Posterior inspection: spinal alignment, iliac crest alignment, muscle wasting, abnormal hair growth, bruising Feel: • Spinal processes then facet joints ~1cm laterally • C7 (Vertebra prominens) more prominent • Sacroiliac joints- alignment and tenderness • Paraspinal muscles- tenderness or muscular spasms (~1cm lateral)SpinalsurgeryMove: Cervical Spine: • Flexion – chin to chest (ROM 0-80) • Extension- Look up (ROM 0-50) • Lateral flexion- Ear to shoulder (ROM0-45) • Rotation- Turn head left to right (0-80) Lumbar Spine: • Flexion- legs straight, touch toes • Extension- Lean back, support from behind (ROM 10-20) • Lateral flexion- slide hand down side of leg Thoracic spine: • Rotation- sit on edge of bed, cross arms and rotate as far as possibleSpecial tests: • Schober’s Test: identify restricted flexion of lumbar spine - Identify PSIS on either side, mark with pen 5cm below and 10cm above, touch toes and measure - Should increase from 15 to >21cm • Straight leg raise test: Sciatic stretch test - Supine on couch, raise leg by ankle with knee fully extended - Normal is 80-90 degrees - Once hip is flexed, dorsiflex patient’s foot - Positive if pain in buttock or posterior thigh • Femoral nerve stretch test - Prone on couch, flex knee to 90 and extend hip, plantarflex patient’s foot - Positive if pain in thigh &/or inguinal region  Introduction,infectioncontrol,consent,exposure  Look,feel,move,specialtests Summary  Thankpatientandsummarise  Remember pointsfrom patientfor professionalism  Questions?