CLINICAL AND RADIOLOGICAL EXAMINATION OF THE SHOULDER JOINT : a guide for advanced practice... physiotherapists

The extended role physiotherapy has been given increased attention over the past decade in North America and Europe. New models of care with expanded scope of practice for allied health professionals have emerged to respond to a continuous increase in the cost of health care and physician and surgeon shortages, especially in settings that provide services to patients with musculoskeletal disorders in rural areas. This text book provides detailed information on history, etiology, clinical findings, and most importantly imaging characteristics of major conditions of the shoulder joint, which clinicians often face in the clinic. At present, there are no books that have incorporated the shoulder joint's different pathologies for extended role therapists, physician assistants, or family physicians in one place. This book facilitates practical learning for busy clinicians who wish to improve their expertise without having to read multiple books on the subject. The first nine chapters of the book incorporate the historical perspective of the common shoulder conditions with details on the pioneers who first introduced the pathology in the medical journals. The clinical and imaging hallmarks of each disorder then follow the historical perspective section to assist with identifying the pathology and selecting the best management. Chapters 10-12 provide detailed information on indications and contraindications for different modes of procedural imaging and the specific presentation of common shoulder pathologies on plain radiographs. Written by the experts in the field, Clinical and Radiological Examination of the Shoulder Joint is a valuable resource for advanced level physiotherapists, family medicine physicians, and specialized physician assistants. Acknowledgments 6 Contents 7 Chapter 1: Diagnostic Clinical Decision-Making in Shoulder Pathology 12 Historical Perspective 12 Definition of Diagnostic Indices 13 Origin of Shoulder Pain 16 Nociceptive Pain 16 Neuropathic Pain 16 Cervical Spine-Related Pain 17 Non-spinal Neuropathic Shoulder Pain 17 Major Categories of Common Shoulder Pathology 20 References 20 Chapter 2: Impingement Syndrome 24 Primary or Outlet Impingement 24 Historical Perspective 24 Intrinsic Factors of Primary Impingement Syndrome 25 Calcified (Calcifying) Tendinitis 25 Extrinsic Factors of Primary Impingement Syndrome 27 Acromion Morphology 27 Subacromial Osseous Impingement 27 Acromioclavicular Joint (AC) Pathologies 29 Osteoarthritis 29 Os Acromiale 29 Osteolysis of the Distal Clavicle 30 Coracoacromial Ligament (CAL) Pathology 31 Coracoid Impingement Syndrome (CIS) 32 Clinical Findings of Primary Impingement Syndrome 32 Internal Impingement Syndrome 33 Clinical Findings and Management of Internal Impingement Syndrome 34 Secondary and Functional Impingement Syndrome 35 References 36 Chapter 3: Biceps Brachii Pathology 41 Historical Perspective 42 Proximal Long Head of Biceps Brachii Pathology 43 Clinical Findings and Management 44 Proximal Short Head of Biceps Brachii Pathology 45 Clinical Findings and Management 45 Distal Biceps Pathologies 46 Clinical Findings and Management 46 References 47 Chapter 4: Tears of Rotator Cuff Tendons 51 Historical Perspective 51 Characteristics, Classification, and Causes 52 Types of Rotator Cuff Tears (Partial Vs. Full Thickness) 53 Importance of Cuff Tear Location and Involvement of Rotator Cable 54 Natural History of Rotator Cuff Disease 56 Clinical Findings of Rotator Cuff Tears 57 Differential Diagnosis 61 Management of Rotator Cuff Tears 62 Partial-Thickness Rotator Cuff Tears 62 Full-Thickness Rotator Cuff Tears 62 Historical Landmarks and Surgical Decision-Making 63 References 64 Chapter 5: Cuff Tear Arthropathy 68 Historical Perspective 68 Characteristics, Classification, and Causes 70 Prevalence of CTA 72 Clinical Findings of Cuff Tear Arthropathy 73 Range of Motion Assessment 73 Pseudoparalysis 74 Strength-Related Clinical Tests 75 Imaging Investigations 76 Management of Cuff Tear Arthropathy 76 References 79 Chapter 6: Frozen Shoulder 84 Historical Perspective 84 Characteristics, Classification, and Causes 85 Incidence and Risk Factors 86 Clinical Findings and Role of Capsular Pattern of Restriction 87 Differential Diagnosis for Frozen Shoulder 88 Conservative and Surgical Management 89 Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) and Oral Corticosteroid 89 Rehabilitation and Manual Therapy 90 Corticosteroid Injections 90 Distension Arthrography 91 Closed Manipulation under Anesthesia 91 Surgical Release of Capsule 92 References 93 Chapter 7: Arthritis of the Glenohumeral Joint 98 Historical Perspective 99 Characteristics, Classification, and Causes 101 Rheumatoid Arthritis of Glenohumeral Joint 103 Capsulorrhaphy Arthropathy 104 Avascular Necrosis or Osteonecrosis 105 Septic Arthritis 106 Neuropathic Arthropathy 106 Rare Genetic and Hereditary-Induced Arthritis 107 References 107 Chapter 8: Superior Labral Anterior and Posterior Lesions 112 Historical Perspective 112 Characteristics, Classification, and Causes 113 Clinical Findings of SLAP Lesions 114 Management 115 References 116 Chapter 9: Glenohumeral Joint Instability 119 Historical Perspective 120 Characteristics, Classification, and Causes 121 Anterior Glenohumeral Instability 122 Posterior Glenohumeral Instability 123 Inferior Glenohumeral Instability 124 Multidirectional Hypermobility (Laxity) 124 Rare Hereditary Disorders 124 Clinical Findings of Glenohumeral Joint Instability 125 Management 126 References 126 Chapter 10: Principles of Radiological Examination 132 Conventional Radiography 133 Standard Anteroposterior (AP) View 133 True Anteroposterior (Grashey) View 134 Supraspinatus Outlet View 135 Scapular Outlet “Y” View 136 Acromioclavicular (Zanca) View 137 Axillary Lateral View 138 Stryker Notch View 139 West Point View 140 Other Diagnostic Imaging Modalities of the Shoulder Joint 141 Ultrasonography (US) 142 Magnetic Resonance Imaging (MRI) without Contrast 142 Magnetic Resonance Arthrography (MRA) 143 Computed Tomography (CT) Scan 143 Disadvantages, Precautions, and Contraindications 143 Conventional Radiography 143 Ultrasonography (US) 144 Magnetic Resonance Imaging (MRI) without Contrast 144 Magnetic Resonance Arthrography (MRA) 145 Computed Tomography (CT) Scan 145 References 146 Chapter 11: Radiographic Features of Rotator Cuff and Biceps Tendon Pathologies 148 Subacromial Impingement Syndrome 148 Inferior Cortical Acromial Sclerosis (Sourcil Sign) 148 Subacromial Spurs 149 Subacromial Enthesophytes 149 Subacromial Osteophytes 150 Greater Tuberosity Cortical Irregularity 151 Calcified Tendinitis 151 Acromion Morphology 153 Acromioclavicular Joint Osteoarthritis 155 Chondrocalcinosis 155 Geyser Cyst 156 Osteolysis of the Distal Clavicle 156 Acromioclavicular Joint Separation 157 Os Acromiale 158 Biceps Pathology 159 Proximal Biceps Tendon Pathology 159 Distal Biceps Tendon Pathology 161 Partial- and Full-Thickness Rotator Cuff Tears 161 Inferior Cortical Acromial Sclerosis (Sourcil Sign) 162 Greater Tuberosity Cortical Irregularity 163 Humeral Head Cysts 163 Subacromial Enthesophytes and Osteophytes 164 Superior Migration of the Humeral Head in Relation to the Glenoid 164 Critical Shoulder Angle 166 Other Imaging Modes of Rotator Cuff Tears 166 References 167 Chapter 12: Radiographic Features of Glenohumeral Arthritis 173 Primary Glenohumeral Osteoarthritis 173 Autoimmune and Inflammatory Arthritis 176 Secondary Glenohumeral Arthritis 178 Cuff Tear Arthropathy 178 Capsulorrhaphy Arthropathy 179 Avascular Necrosis (AVN) or Osteonecrosis 180 Septic Arthritis 182 Neuropathic Arthropathy 183 Metabolic Conditions and Glenohumeral Joint Arthritis 185 Radiographic Features of Glenohumeral Instability 185 Anterior Glenohumeral Instability 185 Hill-Sachs Lesions 185 Bankart Cartilaginous and Bony Lesions 186 Posterior Glenohumeral Instability 188 Imaging Features of Capsular, Labral, and Rare Pathologies 189 Adhesive Capsulitis 189 Superior Labral Pathologies 190 Benign Bone Tumors 191 Malignancy 191 References 193 Index 197