Specialists

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Small Tears Less Than 1 Centimeter

Smaller tears are easily missed as patients present with findings and symptoms consistent with impingement. Occasionally weakness is present, but even following the Neer test, significant weakness may not be detected.

These tears usually involve the supraspinatus tendon insertion, and pain is the primary presenting complaint. Examination usually reveals normal motion and strength.

After the […]

Capsular Lesions

Traumatic intra-substance injury of the joint capsule is commonly associated with anterior dislocation. Depending on the magnitude of the anterior shear force, either plastic deformation or a complete tear of the joint capsule can occur.

The recognition of a concomitant posttraumatic capsular laxity or rupture and a Bankart lesion is essential in order to select […]

SPECIFIC TESTS-Medial shearing

Significance

This test is used to detect internal derangement at the inner side of the knee. Pain on jerk is suggestive for a minor lesion at the tibial insertion of the anterior cruciate ligament.

Positioning.

The subject lies in the supine position with the knee flexed to a right angle, and the heel resting […]

Palpation of the extensor mechanism

This is performed on an extended knee.First the muscular structures are ascertained. Ask the patient to extend the slightly bent knee and resist the movement.This movement usually outlines the vastus medialis, vastus lateralis, rectus femoris and the patellar ligament. Then the patellar border with its tendinous insertions are palpated. With the hip in flexion and […]

Palpation of soft tissue

Feel for the pisiform bone and place the palpating finger against its proximal aspect. Ask the subject to actively abduct the little finger. The tightening of the flexor carpi ulnaris can be felt.The tendon can now be followed distal to the pisiform until its insertion on the base of the fifth metacarpal bone. The pisiform […]

Passive pronation

Positioning.

The subject stands with the arm hanging and the elbow bent to a right angle. The examiner stands in front of the subject. Both hands encircle the distal forearm in such a way that the heel of the contralateral hand is placed against the volar part of the ulna and the fingers of the […]

Palpation of soft tissue

Over the olecranon lies the olecranon bursa,which is only really palpable when it becomes inflamed and swollen.Keep the subject’s elbow flexed. Palpate for the upper border (apex) of the olecranon. Feel just lateral to this apex for the insertion of the tendon of the triceps muscle. Move the fingers upwards: a broad and flat tendon […]

Posterior cruciate ligament injuries

PCL tears of the knee are not very common; they constitute only 5-10% of all major knee ligament tears.

Anatomy The PCL has an average width of 0.5 in (13 mm) and length of 1.5 in (38 mm). It is fan-shaped, being narrowest in the midportion and fanning out superiorly and, to a lesser extent, […]

Rupture of the Major Pectoral Muscle

The pectoral muscle has its origin on the anterior chest wall and its insertion on the anterior surface of the upper part of the humerus. Its function is to draw the upper arm towards the chest and to rotate the arm inwards. When it is subjected to a heavy load, the pectoral muscle can tear. […]

Types of Injury to the Muscle-tendon Complex

Muscles and tendons function together as units. In principle, injuries can affect the muscle origin, the muscle belly, the point at which muscle and tendon merge (the muscle-tendon junction), the tendon itself,and the insertion of the tendon into bone and periosteum. In practice, injuries to the muscles usually occur at the muscle-tendon junction regardless of […]