We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section 5 - Orthopaedic surgery
Published online by Cambridge University Press: 05 July 2015
Checklist
WIPER
• Patient standing in shorts or underwear with shoulder girdle exposed (bra to remain on in women).
• Expose upper limb and cervical spine.
Physiological parameters
• Observe for spinal lordosis, kyphosis or scoliosis.
Look
• Skin: erythema, scars, sinuses, symmetry of skin creases or skin elevation from underlying fracture
• Soft tissues:
• joint and soft tissue swelling
• wasting of deltoid, biceps, supraspinatus and infraspinatus muscles
• Bone: prominence of acromion, clavicular asymmetry or deformity
Feel
• Skin: temperature, tenderness, sensation
• Soft tissues:
• muscle mass: trapezius, deltoid, triceps, biceps and biceps tendon
• ligaments: coracoclavicular ligaments
• radial and ulnar pulses, capillary refill time
• sensation in ‘regimental badge' area (axillary nerve) and in hand
• Bone:
• sternoclavicular joint
• clavicle: deformity or malunion
• acromioclavicular joint
• coracoid process
• spine and borders of the scapula
• greater tuberosity of humerus
• margins of glenoid cavity
• cervical spine
Move
• Active and passive:
• flexion/extension
• internal/external rotation
• abduction/adduction
• Resisted:
• deltoid
• serratus anterior (winging of the scapula)
• pectoralis major
• trapezius
Special tests (* = essential tests)
• Acromioclavicular test*
• Impingement test*
• Instability and apprehension test*
• Rotator cuff test*
• Biceps tendon test
• SLAP test
• Thoracic outlet syndrome tests
To complete the examination…
• Examine the joint above (cervical spine: up to 30% of shoulder pain is referred from the cervical region) and the joint below (elbow).
• Check full neurovascular status of the upper limb.
• Order appropriate radiographs and further imaging.
Examination notes
What do you look for during initial observations?
• Assess the skin quality and contours of the shoulder girdle, clavicle and scapula.
• The soft tissues mass and muscle bulk are evaluated for evidence of muscle loss from disuse atrophy, found around the scapular from rotator cuff atrophy or pectoral muscles anteriorly. Deltoid muscle atrophy can also be found in axillary nerve injury.
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
