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Dislocated shoulder: how is the consultation?

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It performs the clinical examination of the shoulder according to the following steps:
 
We note and we question the patient on the following characteristics: age, sex, dominant hand, the type of sport and the level of competition on the direct trauma risk factors for shoulder instability.
 
is determinedthe symptoms experienced by the patient and their descriptions. One shoulder may have three predominant symptoms: stiffness, pain and instability. Here, we investigate the circumstances of dislocation episodes, the intensity of the trauma (fall sports accident, the highway accident).
At what age is held the 1 st dislocation? And other subsequent episodes also.
 
Then is performed the patient's physical examination: the size and weight, the mobility of the shoulder according to 4 angular sectors, in front (or forward flexion), backward (or retropulsion), on its side (abduction) and in rotation. It also performs a neurological examination of the shoulder to look for violations that occurred during luxation (decrease or disappearance of the sensitivity of an area of the arm or decrease in the strength of one or more arm muscles). We test the shoulder muscles especially the subscapularis (see page examination of the tendons of the shoulder) and the biceps tendon.
 
Wanted laxity during the testing of the shoulder.
There are 3 different directions being tested. Abnormal laxity Wanted forward, downward and backward. We say that a patient is hyperlaxe if the measured rotation elbow to the body is greater than 85 ┬░.
 
Then looking to replicate the apprehension of dislocation by putting the shoulder in position The discomfort felt by the patient. Whether the shoulder will dislocate or the presence of a gene or pain means the test is positive.
 
- An anterior apprehension test (Figure 1) is performed by reproducing the armed gesture countered (hand ball shoot or smash volleyball).
anterior apprehension test clinically unstable shoulder chirurgiedusport burly Lefevre herman
Figure 1 anterior apprehension test conducted in land army position
 
- A posterior apprehension test (Figure 2) made ??antepulsion, internal rotation
posterior apprehension test clinically unstable shoulder chirurgiedusport burly Lefevre herman
2 posterior apprehension test conducted in forward flexion / internal rotation / retropulsion
 
- A lower apprehension test (Figure 3) made ??of abduction.
apprehension test less unstable shoulder physical examination chirurgiedusport burly Lefevre herman
Figure 3 Test less apprehensive performed in abduction thwarted
 
These three tests can be carried out with the patient sitting or lying on the examination table.
Finally, another test called "relocation test" or refocusing test (Figure 4). The patient feels discomfort when moving the humeral head forward (Figure 4a), which is relieved by refocusing touch the doctor back (Figure 4b).
 
relocation test or physical examination refocusing test unstable shoulder chirurgiedusport burly Lefevre hermanrelocation test or physical examination refocusing test unstable shoulder chirurgiedusport burly Lefevre herman
Focus test or "Relocation test"
Figure 4a: humeral head forward Figure 4b: humeral head back
 

Doctor Yoann BOHU, Doctor Nicolas LEFEVRE, Doctor Serge HERMAN. - 1 d├ęcembre 2013.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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