Examen fisico de hombro, ortopedia y traumatologia

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PHYSICAL EXAMINATION
Cervical Spine (Neck)
The physical examination of the shoulder begins at the neck. Pathology within the cervical spine can manifest
with arm pain and nerve symptoms that radiate down the arm. The patient might believe the source of the
problem is somewhere other than the neck. The examiner begins by standing behind the patientand observing
the neck and shoulder girdle for symmetry, muscle mass, scars, and deformity. The examiner assesses the ROM
including extension, flexion, rotation, and bending. This is best done while standing behind the patient. Because it
is difficult to use a goniometer to make measurements, surface relationships are commonly substituted.
Neck extension (Fig. 4-3) is recorded by noting that theimaginary line from the occiput to the mentum of the chin
extends beyond the horizontal. Flexion is recorded by noting how many fingerbreadths the chin is from the chest
when the patient flexes the neck as much as possible (Fig. 4-4). The patient leans the head to the side while
looking forward (Fig. 4-5), and the distance from the shoulder to the ear is recorded for lateral flexion. Lastly,the
patient turns the head from side to side and the examiner notes the degree of rotation. These cervical spine
motions are made actively (by the patient) rather than passively (by the examiner).

FIGURE 4-3 Neck extension is measured by imagining a line drawn from the occiput to the mentum of the chin and estimating the
angle subtended between this line and a horizontal plane.http://www.expertconsultbook.com/expertconsult/b/book.do?metho…160-3427-8..50010-6--cesec17&type=bookPage&contentStyle=print

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FIGURE 4-4 Neck flexion is measured by imagining a line drawn from the occiput to the mentum of the chin and estimating the
angle subtended between this line and a horizontal plane.http://www.expertconsultbook.com/expertconsult/b/book.do?metho…160-3427-8..50010-6--cesec17&type=bookPage&contentStyle=print

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FIGURE 4-5 Lateral bending of the cervical spine is assessed by estimating the distance between the ear and the shoulder.

The Spurling test (Fig. 4-6) is performed by placing the cervical spine in extension and rotating the head toward
theaffected shoulder. An axial load is then placed on the spine. Reproduction of the patient's shoulder or arm
pain is considered a positive response.

http://www.expertconsultbook.com/expertconsult/b/book.do?metho…160-3427-8..50010-6--cesec17&type=bookPage&contentStyle=print

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FIGURE 4-6 The Spurling test is performed by axiallyloading the top of the head with the cervical spine extended and the head
rotated toward the affected shoulder. A positive test reproduces the shoulder pain.

Although a detailed neurologic examination is beyond the purview of most shoulder examinations, clinical
judgment determines the degree of peripheral nerve assessment necessary to establish a correct and complete
diagnosis. Examining thestrength of the trapezius, deltoid, spinati, and biceps and triceps muscles suffices for
most general shoulder examinations. However, in some situations a more thorough examination needs to be
completed, which includes assessment of motor and sensory distributions of each peripheral nerve of the upper
extremity or extremities.

Shoulder
Inspection
Inspection of both shoulders can revealpathology that would otherwise go unnoticed if the examiner relied solely
on the patient history or physical examination. Both shoulders need to be exposed (Fig. 4-7). First, observe the
clavicles for deformity at both the sternoclavicular joint and acromioclavicular joint. A prominent sternoclavicular
joint can be due to an anterior dislocation, inflammation of the synovium, osteoarthritis,...