Rockwood Adults CH34

1068

SECTION TWO • Upper Extremity

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Figure 34-4.  A: The left shoulder after trauma appears to be centered and located on the Grashey view. B: Axillary view shows the humeral head is posteriorly dislocated and locked onto the glenoid with a large reverse Hill–Sachs lesion ( arrow ). These images are of the same patient who presented to the emergency room after trauma to the left shoulder.

abduction which may be too painful for a patient who pres- ents with an acute shoulder dislocation (Fig. 34-8B). Evaluation of the infraspinatus is performed by applying resisted external rotation with the elbow flexed to 90 degrees and, again, is per- formed within the patient’s comfortable ROM (Fig. 34-8C). Occasionally, patients will describe a history of a dislocation event and have subsequent specific complaints of instability or subluxation. Besides a description of instability or recurrent

dislocations, the most common complaint of shoulder insta- bility is pain coupled with restricted shoulder motion. Patients with anterior shoulder instability will experience symptoms of apprehension with shoulder abduction and external rotation, and also can experience symptoms of pain and instability with placement of the arm in an overhead position. It is important for the clinician to look for these signs when evaluating patients with suspected shoulder instability and shoulder pain.

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Figure 34-5.  A: Both passive and active forward flexion in the plane of the scapula is measured with the patient sitting. B: Abduction is measured with the scapula stabilized.