Ayman the swimmer

Ayman the swimmer

1. Anatomy

   • bones of the shoulder
     • clavicle
     • Scapula
     • humerus
   • Axilla
     • Pyramid shaped space between upper arm and side of chest.
     • The main pathway by which nerves, blood vessels, and lymphatics pass
     • from root of neck towards upper limb.
     • boundaries
       • Anterior
         • posterior border of clavicle.
       • medial
         • outer border of first rib.
       • Lateral
         • upper border of scapula.
     • Base of axilla is made of skin and soft tissue.
   • Joints of of the shoulder
     • Acromioclavicular joint
       • articulates acromion process and lateral end of clavicle
       • synovial plane
     • sternoclavicular joint
       • articulation of clavicular notch of manubrium and medial end of clavicle
     • scapulothoracic
       • Physiological articulation not anatomical
     • Glenohumeral
       • Articulation of head of humerus with glenoid cavity
       • surrounded by the rotator cuff

2. clinical examination

   • inspection
     • scars
     • trapezius muscle asymmetry
       • suggestive of muscle wasting due to atrophy or a spinal accessory nerve lesion.
     • suprasinatus and infraspinatus asymmetry
       • suggestive of muscle wasting secondary to chronic rotator cuff tear or a suprascapular nerve lesion.
     • scoliosis
       • urvature of the spine that may be congenital or acquired.
     • winged scapula
       • ask the patient to push against a wall with both hands spaced shoulder-width apart whilst you inspect the back
       • protrusion of the scapula suggests serratus anterior muscle weakness secondary to a long thoracic nerve injury
   • Movement
     • Active movement:
       • movement performed independently by the patient.
     • Passive movement
       • movement of the patient, controlled by the examiner.

3. shoulder impingment test

   • Neer test
     • stabilize the scapula
       • internally rotate the patient's arm and preform maximally forced forward flexion i
   • Hawkin's test
     • patient in sitting position.
       • arms at 90 degrees of shoulder and elbow flexion
         • fixate the scapula
           • add internal rotation to the glenohumeral joint

4. shoulder impingement syndrome

   • painful pinching of the rotator cuff or subacromial bursa by the acromion above
     • the rubbing of the rotator cuff tendons or bursa (due to overuse/injury) result in swelling,
       • narrows the space below the acromion and leads to rubbing/impingement.
   • symptoms
     • Muscle weakness
     • Reduced range of motion
     • Pain and swelling in top/front of shoulder

5. confirmatory tests

   • radiography
     • Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form
   • ct scan
     • Uses x-rays to produce images from different angles of the body so a 3D image can be constructed.
   • nuclear medicine
     • isotope is injected into the patient and then gamma cameras are used to detect the amounts of the isotope in different areas or organs.
   • MRI
     • Uses strong magnets and radio waves to excite the hydrogen atoms in the water in our body.
   • ultrasound
     • Uses high frequency sound waves made by a transducer which are then reflected back to it by the internal structures of the body

Bilder und Dateien der Mindmap