Orthopaedic Research Unit Dept. of Orthopaedic Surgery and

Orthopaedic Research Unit Dept. of Orthopaedic Surgery and

Skulderen
Orthopaedic Research Unit
Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Inst. of Clinical Research – University of Southern Denmark
www.sdu.dk/ki/orto
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Skulder undersøgelse
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Andre skuldertest
• Instabilitet
–
–
–
–
•
Anterior draw
Posterior draw
Sulcus test
Apprehension
AC-led
– AC resisted extension test
– Cross over
•
Biceps
– Speed
– Yergason
• SLAP
– O’Brians
– Biceps load
•
Thoracic Outlet
Syndrome
– Adson
– Roos
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 1
• 50 årig slagter med smerter i højre skulder, når den
løftes op til vandret.
• Inspektion: Let atrofi af supraspinatus
• Palpation: smerter ved supraspinatus muskelbug +
insertion
• Bevægelse: Smerter ved aktiv abduktion - smertebue
45-135 grader.
• Test: Positive impingement tests. Ingen droparm
 Normal neurovaskulære forhold
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 1
• Du er i ambulatoriet: 50 årig slagter kommer
med smerter i højre skulder, når den løftes op til
vandret.
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Impingement
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Impingement
• Test
– Smertebue
– Neers
– Hawkins / Kennedy
– Copeland
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Rotatorcuff skade
A. Partiel supraspinatusruptur, yngre, akut
skade
B. Partiel læsion i rotatorintervallet, >40 år,
akut skade
C. Gentagne traumer, multidirektional, yngre
D. Impingement slid, >40 år
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Rotatorcuff patologi
• Test
– Droparm
– Rent sign (palpation)
– Nedsat kraft/smerter ved udad rotation
– Impingement
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 2
• 25 årig håndboldspiller faldet ned på venstre
skulder.
• Normal inspektion
• Palpation: Smerter af AC-led ved palpation
• Bevægelse: Smerter ved bevægelse over 90
grader, forværres ved adduktion
• Test: Normale neurovaskulære forhold
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 2
• Du er i skadestuen: 25 årig håndboldspiller
faldet ned på venstre skulder.
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
AC-leds luxation
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Glenohumeral Luksation
Anterior luksation
Posterior luksation
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto