Specialists

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Clinical Evaluation

The most common mechanism for sustaining a pectoralis muscle injury is from weight-lifting or athletics. Wolfe et al.It described the transition period from eccentric loading to concentric loading (bench press position) as the most stressful to the inferior muscle fibers of the pectoralis muscle. The patient typically presents after sudden onset of pain in the […]

Anatomy

The anatomy of the pectoralis major muscle demonstrates two distinctively different parts—the clavicular head and the sternal head . We feel that when evaluating injuries to the pectoralis it is important to understand the anatomy of the pectoralis major muscle complex.

Unfortunately, many of the published reports never comment on this difference, or describe it […]

Cartilage

Key Points

Full-thickness articular cartilage defects have a limited capacity to heal. Thus, articular cartilage lesions and osteochondral defects in any joint present a challenging problem. Cartilage lesions are less likely to be seen in the glenohumeral joint than in the knee, therefore there has not been extensive research on shoulder cartilage repair. Making the […]

The Nord Technique

Glenohumeral arthroscopy is performed in the lateral decubitus position under 10 lbs. of traction as described in the preceding paragraphs. The arm is suspended at approximately a 45-degree angle of abduction and 10 degree forward flexion and distraction of the shoulder joint is accomplished with 10 lbs. of traction. This allows for external and internal […]

Clinical Evaluation-Physical Findings

Distinguishing anterior shoulder pain caused by biceps tendon disorders as opposed to subacromial impingement can be difficult, as these two entities usually co-exist. Although there are some exam maneuvers, which attempt to isolate the biceps tendon, there is still a fair amount of overlap and the definitive diagnosis of isolated biceps tendon pathology is extremely […]

Partial Thickness Rotator Cuff Tears: Treatment

Partial thickness rotator cuff tears can result from intrinsic cuff degeneration and tendinopathy absent an injury or impingement. The lack of uniformity of collagen bundles and the paucity of vascular supply contributes to weakness, especially along the articular aspect of the rotator cuff. These degenerative tears often exit the articular surface and can be well […]

Impingement: Secondary

Individuals with shoulder instability or other underlying pathology can develop significant abnormal mechanics that can lead to rotator cuff functional disability, eventual fatigue and loss of humeral head containment. When this occurs, rather than the coracoacromial arch moving toward the cuff, the cuff migrates cephalad as containment is compromised.

In addition to articular-sided internal impingement-type […]

Clinical Evaluation-Physical Examination

After completing a detailed history, a focused examination can be undertaken. It is critical to compare extremities as the unaffected shoulder can serve as a “normal” template to which one can compare. One should survey for atrophy or asymmetry, especially in the supra and infraspinatus fossae. Long-standing rotator cuff tears are often accompanied by significant, […]

Imaging

The minimum radiographic workup necessary for evaluation of an acute dislocation or suspected subluxation is a true anteroposterior (AP) view and an axillary lateral view. These images will allow accurate determination of the position of the humeral head relative to the glenoid.

A true AP radiograph is obtained by angling the x-ray beam 45 […]

Physical Findings

A systematic evaluation includes observation for abnormal motion patterns and atrophy, palpation to localize painful areas, assessment of both active and passive range of motion, measurement of strength of the rotator cuff, deltoid and scapular stabilizer muscles, neurovascular examination, and finally provocative testing maneuvers for instability. It is important to examine the opposite shoulder for […]