Optimal Methods for Shoulder Tendon Palpation.. A Cadaver Study

GE Mattingley, PhD,PT; PJ Mackarey, PT

Phys Ther. 1996;76:166-174

Background and Purpose. Physical therapists often must either palpate tendons of the shoulder or, as part of treatment, apply forces to those tendons. Many methods have been suggested for minimising the amount of soft tissue that overlies these tendons, but no data have been presented to justify the use of any approach. The purpose of this study was to evaluate methods described in the literature by use of cadaver models. Subjects. Twenty-four shoulders from 12 cadavers of individuals aged 55 to 92 years were dissected. Methods. Shoulders were placed in the positions described in the literature, and the positions in which the tendons were maximally exposed (i.e., had the least overlying tissue) were noted.

Results. Positions were found in which tendons were maximally exposed.

Supraspinatus Tendon

The shoulder position that produced the maximum visual exposure of the supraspinatus tendon with the least amount of overlying tissue was maximal shoulder adduction, maximal medial rotation and maximal hyperextension. In this position the distal portion of the supraspinatus, tendon is repositioned from under the acromion to a point anterior to the acromioclavicular joint. This position is similar to the forearm-behind-the-back position except for the maximal degree of hyperextension; that is, the forearm is held as far posterior from the lower back as the patient can tolerate. In this position, elbow flexion was maintained at approximately 90 degrees. Shoulder adduction was approximately 10 degrees and limited by contact with the thoracic wall. Medial rotation ranged from 80 to 90 degrees. Hyperextension ranged from 30 to 40 degrees. The amount-of exposure of the tendon is predominately dependent on the amount of hyperextension

 

Infraspinatus and Teres Minor Tendons

The position that produced maximum visual exposure of the Infraspinatus and teres minor tendons with the least amount of overlying tissue was shoulder flexion to 90 degrees, 10 degrees of shoulder adduction and 20 degrees of shoulder lateral rotation. In this position, the infraspinatus tendon is deep to the posterior deltoid muscle and inferior to the acromial angle. Cyriax advocated using this position with the patient lying prone We found that this shoulder position exposes the tendons to the same degree as with the patient sitting

 

Subscapularis Tendon

The position that allowed maximum visual exposure of the subscapularis tendon with the least amount of' overlying tissue was with the shoulder adducted to the side of the thorax and neutral in terms of flexion/extension and medial/lateral rotation . In this position, the tendon can be located deep in the deltopectoral triangle between the long and short heads of the biceps brachii muscle. By using the "doorway of the deltopectoral triangle, the tendon of the subscapularis muscle can be palpated without the intervening deltoid muscle.

The proposed position of adduction and medial rotation of' the shoulder also places the tendon in the deltopectoral triangle between long and short heads of the biceps brachii muscle. Yet, with this position, only the insertion of the subscapularis tendon can be palpated. Most of the tendon of the muscle is found deep to the short head of the biceps brachii muscle and the coracobrachialis muscle

The position of' shoulder extension and lateral rotation places the lesser. tuberosity and the attached tendon of the subscapularis muscle deep to the deltoid muscle.


 

Anatomische en kinesiologische studie van de rotatorcuffpezen

P. H. VAES, J. M. ANNAERT, Ph. CLAES, P. OPDECAM
Nederlands tijdschrift voor Manuele Therapie
VOL. 11 - 1992 - NR. 1

SAMENVATTING

Uit literatuurstudie blijkt dat er onduidelijkheid bestaat over de correcte posities waarin men de arm moet plaatsen om ter hoogte van de acromiale boog een nauwkeurige en betrouwbare palpatie van de rotatorcuffpezen te kunnen uitvoeren. Dit is zowel bij onderzoek als bij behandeling van aandoeningen van de rotatorcuff een noodzaak.
Een kadaveronderzoek bracht aan het licht dat alleen bij nauwkeurig ingenomen posities van de arm (overeenstemmend met passieve test-bewegingen) de volledige pezen van de respectievelijke spieren voor onderzoek, palpatic of therapie toegankelijk zijn.
Gebruik makend van videobeelden werd een kinesiologische studie van de peesverplaatsingen tijdens de verschillende passieve testbewegingen uitgevoerd.

Voor de pees van de m. supraspinatus is dit extensie, endorotatie, en adductie.

Voor de pees van de m. infraspinatus is 45' anteflexie (zonder abductie) noodzakelijk.

Voor de pees van de m. teres minor kan dit in neutraalstand, met de arm naast het lichaam.

Voor de pees van de m. subscapularis is het nodig de arm in maximale exorotatie (80°) te plaatsen.

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