Shoulder internal rotators

Fig. 6.19a,b. Clinical tests for assessing the strength of rotator cuff muscles, a Supraspinatus strength is tested with the patient s arm in a position of 60° of forward elevation with the shoulder internally rotated and the elbow extended. A downward force (arrow) applied by the examiner is resisted by the patient, b A lift-off test is performed to evaluate subscapularis strength. The patient is asked to actively lift (arrow) the hand off of the lumbar region... 

The proximal humeral epiphysis arises from two, sometimes three separate ossification centres (Fig. 7.12). The first ossification centre develops medially at about 2 weeks of age and the second ossification centre develops in the greater tuberosity between 6-12 months of age. When the arm is internally rotated, the first appearing medial ossification centre is rotated into a lateral position and can give the false impression of shoulder joint disruption. The rare third centre occurs in the lesser tuberosity in the third year of life, and when visualised on the axillary shoulder view, may be mistaken for a fracture. This ossification centre fuses with the shaft of the humerus at 6-7 years of age. The radiolucent proximal physis of the humerus is tented and in various oblique positions can be mistaken for a fracture (Fig. 7.13). The normal bicipital groove in the proximal humerus may simulate periosteal new bone formation (Fig. 7.14). 

FIG. 73-1 Facilitated positional release treatment for first rib dysfunction application of compression with internal rotation of the shoulder. 

Note The amount of flexion and whether abduction-external rotation or adduction-internal rotation is applied will follow the same notes as for the shoulder joint. 

Aiso known as adhesive capsulitis, frozen shoui-der resuits from proionged immobiiization ofthe shouider. Frozen shoulder may result from application of a splint or sling, or from failure to move the shoulder because of pain from trauma or an inflammatory process in the shoulder, inflammatory and fibrous changes occur in all the periarticular soft tissues. The range of motion of the shoulder can be markedly restricted, with abduction and internal rotation usually the most affected. Patients should be instructed to exercise the shoulder. Complete immobilization should not be continued for more than 48 hours except under supervision of a physician then, physical therapy should be begun as quickly as possible. 

MOTOR RESPONSE None Extension Flexor response Withdrawal Localizes pain Obeys commands 1 = To any pain limbs remain flaccid 2 = Shoulder adducted and shoulder and forearm internally rotated 3 = Withdrawal response or assumption of hemiplegic posture 4 = Arm withdraws to pain, shoulder abducts 5 = Arm attempts to remove supra-orbital/chest jnessure 6 = Follows simple commands... 

Two rotatory vibrations are degenerate for X(jt,0,0), G(ji,5b.0)> U(jt, Jt, 0), A( g, 7t, 0) and Z(0, ji,0) where 5, and/or 5b = 7t. For these rotatory vibrations, (0v/0 e)o = O shown in Fig. V.4(c), (d), (e) and (f), and accordingly rotatory vibrations of the polyethylene chain give rise to a prominent peak near 150cm" . These rotatory vibrations, however, turn into internal-rotation vibrations as the phase difference is increased from = 0 to tc. Vibrational frequencies change little with and a broad shoulder is observed on the high-frequency side of the peak near 150 cm" (see Fig. V.8). 

There are three degree of freedom involved to construct this model represented by three angles qi, q2, and qs. Each angle represent three movement of the shoulder namely flexion/extension, adduction/abduction and external rotation/internal rotation. 

After the biceps has been examined, the patient is asked to rotate the arm externally in order to evaluate the subscapularis tendon on the anterior aspect of the shoulder. This maneuver stretches the subscapularis and helps to move its tendon from underneath the coracoid process into a more superficial position for an adequate examination (Fig. 6.25). Dynamic scanning during passive internal and... 

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