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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 […]

Principles of Instability Surgery

The goal of treatment in both open and arthroscopic instability surgery is twofold: to restore the labrum to its anatomic attachment site and to re-establish the appropriate tension to the inferior capsuloligamentous complex of the joint. Cadaveric studies have shown that both the labrum and the capsule must be injured for a dislocation to occur.

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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 […]

Passive lateral rotation in prone position

The subject lies in the prone position with both knees flexed to a right angle. The examiner encircles both heels and performs a bilateral external rotation. The range of movement is assessed by the twisted position of the feet. This test may be decisive in comparing the range of external rotation.

Common pathological situations:

• […]

FUNCTIONAL EXAMINATION OF THE KNEE

Introduction/general remarks

The knee is the largest and most complex joint of the human body. Because it is situated at the ends of two long lever arms it is very well suited to clinical testing. Furthermore, the joint is relatively uncovered by muscles which facilitates palpation of most structures, intra-articular structures excluded.

One should warn […]

Resisted flexion of the knee

Positioning.

The subject lies prone with the knee in 30° of flexion. The examiner stands level with the thigh and leans over the subject. One hand is on the ilium, the other presses against the distal end of the lower leg.

Procedure.

Ask the subject to flex the knee, and resist the movement .

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Resisted flexion of each finger separately

Positioning and procedure.

The subject presents his hand palm downwards. The examiner stabilizes the wrist with one hand. With the other hand he applies resistance to the distal phalanx of each finger respectively.

Common mistakes.

None.

Anatomical structures tested:

Muscle function:

• Flexor digitorum superficialis • Flexor digitorum profundus.

Common pathological situations:

• […]

Muscles controlling the fingers-Resisted extension of each finger separately

Positioning and procedure.

The subject presents his hand palm downwards. The examiner stabilizes the wrist with one hand. With the other, he applies resistance to the distal phalanx of each finger respectively.

Common mistakes.

None.

Anatomical structures tested:

Muscle function:

• Extension of the index finger:

– Extensor indicis proprius – Tendon to the index […]

Resisted extension

Positioning.

The subject stands with the arm alongside the body, the elbow flexed to 90° and the forearm in supination. The examiner stands level with the elbow. One hand supports the distal part of the forearm and the other hand is on top of the shoulder.

Procedure.

Resist the subject’s attempt to extend the elbow.

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Resisted flexion of the elbow

Positioning.

The subject stands with the arm alongside the body, the elbow bent to a right angle and the forearm in full supination. The examiner stands level with the subject’s hand.One hand is on top of the shoulder and the other on the distal aspect of the forearm.

Procedure. Resist the subject’s attempt to […]