Shoulder with Dr Justin (Long case approach)

Описание: 00:00 Inspection (Swelling Scar Sinus Skin Changes, Wasting, Aptitude, Deformity)
00:26 Feel (Temperature, tenderness)
01:32 Move (Abduction Adduction Flexion Extension Internal External Rotation)
02:34 Info: Painful Arch - Impingement syndrome
02:49 Info: Drop Arm sign - Supraspinatus tear
03:51 Info: Composite Internal Rotation
05:25 Overview of Rotator Cuff Muscles (RCM) - Strength of tendons
05:52 RCM - External Rotation Lag Sign - Infraspinatus weakness
06:43 RCM - Hornblower Sign - Teres Minor weakness
08:17 RCM - Jobe's Test - Supraspinatus weakness
09:46 RCM - Gerber's Lift-off test - Lower Subscapularis Weakness
10:00 RCM - Napoleon Belly Press test - Upper Subscapularis Weakness
10:28 RCM - Bear Hug test - Subscapularis Weakness
11:35 Elderly shoulder - ACJ Arthritis, Impingement Syndrome, Bicipital Tendinitis
12:00 Special Test - Hawkin Kennedy Test - Impingement Syndrome
12:42 Special Test - Neer's Sign - Impingement Syndrome
13:10 Special Test - Neer's Test - Impingement Syndrome
13:43 Special Test - Scarf Test - ACJ Arthritis
14:15 Special Test - Speed Test - Bicipital Tendinitis
14:39 Special Test - Yergason's Test - Bicipital Tendinitis
15:17 Screening - Cervical Spine
16:27 Instability of Shoulder
16:35 Special Test - Anterior Shoulder Apprehension Test - Anterior Instability
17:07 Special Test - Anterior and Posterior Drawer Test
17:28 Special Test - Sulcus Sign
18:02 Info - Frozen Shoulder
20:24 Summarizing Findings from Physical Examination
21:09 Diagnosis - (OA, AVN, Frozen Shoulder, Impingement syndrome, Bicipital Tendinitis, ACJ arthritis, Referred pain)
23:08 Imaging - AP view, Supraspinatus Outlet View
23:41 Info - Bigliani Classification of Acromion Undersurface
24:22 Info - Features of OA - Loss of joint space, osteophyte formation, subchondral cyst, subchondral sclerosis
24:56 Ultrasound first, not MRI (MRI indicated for acute traumatic tear, failed conservative treatment)
25:46 Advantages of Ultrasound - Cheap, Easily available, Can be done at bedside, Dynamic Assessment, Sensitive and Specific for Rotator Cuff Tears
26:19 Disadvantages of Ultrasound - Operator dependent, Unable to evaluate intraarticular pathology
27:08 Management - Conservative - Rest, activity modification, physiotherapy, ROM exercise, RCM strengthening, Periscapular muscle strengthening, Analgesia (200mg Celebrex)
27:25 Info: Subacromial Injection (40mg Triamcinolone (1ml) + 1ml Lignocaine) 2cm inferior and medial to lateral edge of acromion
28:06 Info: Surgery (Read in Description)
RC tear - Repair/Debridement
Bicipital Tendinitis - Tenotomy or Tenodesis
ACJ arthritis - Resect lateral 1-1.5cm of clavicle (Mumford procedure)
Glenohumeral Joint Arthritis - Shoulder Replacement
Impingement Syndrome - Arthroplastic Acromyoplasty/Subacromial decompression

Credits: Dr Justin Chin
Model: David Kwong
Videographer: Ngio Hua Yi & Tan Jia Kai
Editor: Cheah Eu Gene