Specialists

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Clinical Evaluation-Radiographic Evaluation

Accurate radiographic evaluation of the fracture of the proximal humerus is essential for diagnosis and treatment. The trauma series is still the standard initial method for evaluating proximal humeral fracture. This consists of anteroposterior (AP) view of the scapula, a lateral, Y-view of the scapula, and axillary view. This series allows evaluation of the fracture […]

Basic Science-Anatomy and Biomechanics

The humerus is the largest bone of upper extremity. The proximal humerus is composed of the humeral head, the greater and lesser tuberosities, the anatomic and surgical necks of the humerus. The humeral head is the most proximal, ball-like region of the humerus that is retroverted (28 to 40 degrees) and articulates with the glenoid […]

Basic Science-Anatomy and Biology

The rotator cuff consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, all of which arise from the scapula and insert into the proximal humerus. The subscapularis muscle is innervated by the upper and lower scapular nerves, and arises from the anterior surface of the scapula, inserting into the lesser tuberosity.

The nerve supply […]

Nonoperative Treatment

A trial of nonoperative care is implemented before surgical intervention is considered. The majority of patients with impingement syndrome can be managed conservatively. The treatment program consists of formal physical therapy, activity modification, anti-inflammatory, and the judicious use of steroid injections into the subacromial space.

By emphasizing the importance of following the rehabilitation protocol and […]

Scapula

The scapula is a flat, triangular-shaped bone that serves as the articulating surface for the head of the humerus as well as provides areas for 17 muscle attachments. With the arm at the side, the scapula overlaps the dorsal surfaces of the second to seventh ribs. It has three prominent projections: the spine, the coracoid […]

Shoulder Anatomy and Biomechanics

Key Points

The shoulder complex is composed of three bones—the clavicle, the scapula, and the humerus—as well as four articulations—the acromioclavicular (AC), the sternoclavicular (SC), the scapulothoracic, and the glenohumeral (GH) joints. The clavicle serves a variety of functions. It acts as a rigid base for muscular attachments of the shoulder, neck, and chest. It […]

Management-Techniques

The technique and approach of surgical decompression of the suprascapular nerve is dependent on the location of the presumed etiology of the nerve dysfunction. If the pathology is at the suprascapular notch, then the transverse scapular ligament and suprascapular notch may be approached anteriorly, superiorly, or posteriorly.

The anterior approach uses a saber-type incision, just […]

Noncatastrophic Cervical Spine Injuries

Noncatastrophic injuries include neuropraxia of the cervical root or brachial plexus (the “stinger” or “burner”), paracentral intervertebral disc herniation, stable fractures, spinal ligament injury, and intervertebral disc injury. These more common syndromes make up the majority of injuries encountered by sports medicine physicians.

Unilateral upper extremity involvement usually represents neuropraxia of a cervical nerve root […]

Palpation of the subscapularis tendon

The subscapularis muscle belly can only be reached by bringing the hand in between the scapula and the thorax. It cannot really be palpated. The tendinous insertion on the lesser tuberosity, however, can easily be palpated. The subject is in a half lying position on a couch, the upper arm along the body and the […]

Palpation of soft tissue

Palpation of the deltoid muscle The deltoid muscle is easy to recognize. It forms the most important muscular mass of the shoulder and is responsible for its round look.The anterior portion overlies the anterior border of the acromion and the lesser tuberosity. The middle portion lies over the lateral border of the acramion and the […]