1. No category

Skulderen
Orthopaedic Research Unit
Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Inst. of Clinical Research – University of Southern Denmark
www.sdu.dk/ki/orto
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Skulder undersøgelse
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Andre skuldertest
• Instabilitet
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–
–
–
•
Anterior draw
Posterior draw
Sulcus test
Apprehension
AC-led
– AC resisted extension test
– Cross over
•
Biceps
– Speed
– Yergason
• SLAP
– O’Brians
– Biceps load
•
Thoracic Outlet
Syndrome
– Adson
– Roos
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 1
• 50 årig slagter med smerter i højre skulder, når den
løftes op til vandret.
• Inspektion: Let atrofi af supraspinatus
• Palpation: smerter ved supraspinatus muskelbug +
insertion
• Bevægelse: Smerter ved aktiv abduktion - smertebue
45-135 grader.
• Test: Positive impingement tests. Ingen droparm
 Normal neurovaskulære forhold
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 1
• Du er i ambulatoriet: 50 årig slagter kommer
med smerter i højre skulder, når den løftes op til
vandret.
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Impingement
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Impingement
• Test
– Smertebue
– Neers
– Hawkins / Kennedy
– Copeland
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Rotatorcuff skade
A. Partiel supraspinatusruptur, yngre, akut
skade
B. Partiel læsion i rotatorintervallet, >40 år,
akut skade
C. Gentagne traumer, multidirektional, yngre
D. Impingement slid, >40 år
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Rotatorcuff patologi
• Test
– Droparm
– Rent sign (palpation)
– Nedsat kraft/smerter ved udad rotation
– Impingement
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 2
• 25 årig håndboldspiller faldet ned på venstre
skulder.
• Normal inspektion
• Palpation: Smerter af AC-led ved palpation
• Bevægelse: Smerter ved bevægelse over 90
grader, forværres ved adduktion
• Test: Normale neurovaskulære forhold
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Case 2
• Du er i skadestuen: 25 årig håndboldspiller
faldet ned på venstre skulder.
• Inspektion (Look)
– Hævelse, ar, stilling, atrofi.
• Palpation (Feel)
– Lokalisering af problem på anatomisk niveau
• Bevægelse (Move)
– Abduktion/adduktion (180/30), Fleksion / Ekstension (150/40), Udad- /
indad rotation (40/80)
• Test
– Neurovaskulært: Sensibilitet, refleks, kraft og puls
– Smertebue, Droparm
• (Neers, Hawkins/Kennedy og Copeland)
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
AC-leds luxation
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto
Glenohumeral Luksation
Anterior luksation
Posterior luksation
Orthopaedic Research Unit – Dept. of Orthopaedic Surgery and Traumatology
Odense University Hospital
Institute of Clinical Research – University of Southern Denmark – www.sdu.dk/ki/orto