Principles of diagnosis

1
Principles of diagnosis

• Accurate pathological diagnosis must be
  supplemented by assessment of etiologic factors
  underlaying the condition, otherwise the injury
  is likely to recure.

2
Etiologic factors

• Training error
• Malalignment
• Faulty technique
• Inappropriot equipment

3
History

• Circumstaces of the injury (acute or over time)
• History of a previous similar injury
• Other injury
• Training history overuse injury?
• Previous investigations (x-ray, MRI, ultrasound)
• Work and leisure activities
• Lifestyle factors
• Equipment
• Technique
• Medical problems
• Medicine
• Family history

4
History

• Position of the shoulder at the time
• Note the severity of the pain
• What aggrevate and what relieve pain
• paindrawing

5
Specific symptom

• Instability
• Recurrent dislocation or subluxation
• Hospital reduction of the shoulder
• Popping, catching or grinding. Injuries to the
  glenoid labrum Superior Labrum Anterior to
  Posterior (SLAP-lesions)
• Dead arm syndrome. Impingement on the
  neurovascular structures

6
Examination

• Observation, posture
• Active movements, shoulder,scapular motion, neck
  and thoracic spine
• Passive movements
• Resisted movements
• Palpation
• Special test, impingement tests (Neer test,
  Hawkins test), instability test (apprehension,
  relocation test, drawer test) , AC joint
  compression.
• Neurologicala examination (reflexes, muscle
  weakness, sensory symtoms)

7
Practical-Shoulder

• A talented 17 year old team handball player has
  been hooked at the time he was aiming at the
  gaol. He got initialy acute server pain and he
  was not able to move the shoulder. He had to go
  to the hospital emediently where they gave him
  the diagnosis acute anterior dislocation/subluxati
  on. The shoulder was relocated by it self. There
  were no nerv or bloodvesels injuries. He has
  never had any other problems from the shoulder
  befor this episode.