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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.
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
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
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