Search

The subcutaneous location of the acromioclavicular (AC) joint renders inspection and palpation relatively simple when compared to other structures around the shoulder. The recognition of acute AC joint injuries in clinical practice is straightforward; however, the underlying etiology may be more difficult to determine in patients with chronic pain related to the AC joint. This chapter serves to review the anatomy, biomechanics, and characteristic physical examination features common in patients with acute and chronic AC joint pathologies using an evidence-based approach.

Acute injuries to the sternoclavicular (SC) joint typically occur as a result of high-energy trauma and, in some cases, may compromise vital mediastinal structures. While acute injuries are relatively uncommon, chronic symptomatology has become a widely recognized source of shoulder pain and dysfunction. The purpose of this chapter is to review the relevant anatomy, biomechanics, and physical examination of the SC joint using an evidence-based approach.

Evaluation of the shoulder can be a difficult and confusing task for many reasons. This book is meant to serve as a guide to physical examination of the shoulder through illustration and demonstration of the most important pathoanatomy, procedural elements, and clinical data involved with the examination process. It is our goal to provide the reader with the means to accurately and efficiently perform the shoulder examination with confidence and accuracy.

The hip is an inherently stable joint as a result of its characteristic osseous topology that allows the femoral head to sit deeply within the highly congruent acetabular fossa. However, despite its bony architecture, instability of the hip has been reported in recent literature. The etiologies of hip instability are most often divided into traumatic and atraumatic causes. Most cases of traumatic instability occur with dislocation or subluxation. Atraumatic hip instability has numerous potential etiologies. Congenital defects involving bone or soft tissues, multiligamentous laxity, certain systemic diseases, or any one of several acquired causes such as previous open or arthroscopic hip surgery may predispose an individual to develop chronic, atraumatic hip instability which can be debilitating. Developmental dysplasia of the hip (DDH) is a frequently cited entity associated with atraumatic hip instability that has yet to be clearly defined in the literature. In most cases, clinical exam and imaging will provide an accurate diagnosis. In addition, hip arthroscopy has been used to identify causes of instability and treat associated pathologies.

Range of motion testing is a necessary component of the shoulder examination. The concepts and techniques described in this chapter are meant to provide a foundation upon which clinicians can conduct individualized examinations according to the patient’s suspected pathology. Specific findings can then narrow the differential diagnosis and direct the clinician towards the performance of various provocative testing maneuvers. In addition, an understanding of each topic is necessary to aid in the interpretation of various clinical studies in the literature.

Disorders of the long head of the biceps (LHB) tendon are quite common and may present a diagnostic challenge since most of these conditions occur simultaneously with other common shoulder pathologies. Due to the presence of nociceptive fibers within its proximal portion, the LHB tendon is most likely a significant pain generator in many types of shoulder disorders. As a result, physical examination of the LHB tendon and superior labral complex is often difficult due to the possibility of confusing results. In addition, the LHB tendon is particularly difficult to study and, therefore, research on the topic is often conflicting. The purpose of this chapter is to review the relevant anatomy and biomechanics of the LHB tendon as it relates to physical examination, to describe the pathoanatomy of the most common conditions related to the LHB tendon, and to provide clinical evidence regarding the various provocative examination maneuvers for the diagnosis of LHB tendon disorders.