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AND SHOUDER
REGIONS
EXAMINATION
OF
THE TRUNK
PAIN
What caused the pain? (acute or chronic)
Where is the pain?
Radiation? (to & from)
Character
Abnormal sensation
Exacerbation and relief?
Course (progressive, regressive , stationary)
IMPORTANT POINTS
Patients occupation
Faulty postural habits?
Abnormal gait?
Medications?
Sphincter & sex abnormalities
PAST HISTORY
- SYSTEMIC DISEASE
- MEDICATION
- SURGERY
FAMILY HISTORY
Examination of the Dorso lumbar Spine
Attitude:
+ PAIN
Patient examined standing
LOSS OF LUMBAR LORDOSIS
LIST
SCOLIOSIS
Attitude:
+ PAIN
Sciatic list.
Decreased lumbar lordosis.
Scoliosis.
xiphoid process
(T7)
Umbilicus
(T10)
Anus
Glans
Babiniski test
Bulbo-cavernosus test
Palpation
Posterior: spinous processes, facets, sacrum
coccyx, iliac crest, ischial
tuberosity and sciatic nerve
Anterior: abdomen organs, aorta,
inguinal area, iliac crest, symphysis
Prone position
Hip extension S1
Knee flexion S1 & S2
Lumber Root Syndromes
Root pain
Dermatome
Muscle weakness
Reflexes abn.
Sensory examination.
Special tests
SLR
Femoral stretch test
SPINAL (PRIMITIVE REFLEXES)
Special tests
Malingerer patient
PLAIN X-RAY
CT
D CT 3
MRI
BONE SCAN
THE SHOULDER
The shoulder region is made of
three bones
Latera Medial
l
Mechanism of injury
Direct trauma.
Indirect trauma:
-fall on outstretched hand(most common)
- fall on the point of the shoulder.
Clinical picture
Pain, swelling.
Deformity, tenderness &
crepitus at the site of fracture.
Drooping of the affected
shoulder.
The patient supports the arm
of the affected side to
decrease the painful
movements.
PATIENT SHOULD BE EXAMINED
FOR:
Other skeletal injuries.
Distal pulsations.?
Investigations
Plain X-ray
Complications
Neurovasular injury.
Nonunion.
Malunion.
Treatment
Conservative treatment:
(main line)
1- Figure of 8 bandage:
NOT RECOMMENDED.
(Why?)
2- Displaced fracture.
Mode of trauma
Fall on outstretched hand.
Minor trauma to old osteoporotic patients.
Major trauma to young patients.
Clinical picture
Pain, swelling & inability to move the shoulder.
Ecchymosis & crepitus over the affected
shoulder.
Deformity due to fracture or to associated
dislocation.
Neurological and vascular examination:
axillary nerve
Plain X ray
C.T scan
Complications
Axillary nerve injury
Deltoid wasting
Malunion
Treatment
Acute dislocation.
Recurrent dislocation.
Direction of dislocation
Described according to the relation of the head
to the glenoid
Posterior.
Inferior.
Mechanism of injury
Physiotherapy program.
TUMOURS
IN THE SHOULDER REGION
A- BENGIN
OSTEOCHONDROMA
TUMOURS
IN THE SHOULDER REGION
A- BENGIN
CHONDROBLASTOMA
TUMOURS
IN THE SHOULDER REGION
B-MALIGNANT
CHONDROSARCOMA
TUMOURS
IN THE SHOULDER REGION
B-MALIGNANT
CHONDROSARCOMA
TUMOURS
IN THE SHOULDER REGION
B-MALIGNANT
SECONDARIES
PATHOLOGICALFRACTURES
IN THE SHOULDER REGION
DEGENERATIVE ARTHROSIS
SUMMERY
Fractures of the middle third of the clavicle is
the most common fracture site.
Axillary artery may be injured in fractures of the
clavicle.
Conservative treatment is the main line of
treatment.
Minor trauma to the upper limb should not be
neglected in old persons.
Axillary nerve is the most commonly affected
nerve in fractures and dislocations of the
proximal end of the humerus.
Open reduction or arthroplasty are the main
line of treatment in cases of displaced fractures
of the proximal humeral end.
Anterior shoulder dislocation is the most
common type of shoulder dislocations.
In anterior shoulder dislocation, the arm is held
in abduction and slight external rotation.
Shoulder immobilization for three weeks is
needed after closed reduction of shoulder
dislocation.
Recurrent shoulder dislocation is the most
common complication of acute dislocation.