Positive shoulder test

Introduction Shoulder test: the patient is sitting or standing, the elbow joint is flexed, and the hand is placed on the opposite shoulder. The elbow can be close to the chest wall. If it can be placed on the opposite shoulder, the elbow should not be close to the chest wall. Or the elbow can be close to the chest wall, but the hand can not be placed on the opposite shoulder, both are positive, suggesting that there may be a dislocation of the shoulder joint.

Cause

The dislocation of the shoulder joint is mostly caused by the transmission of violence or leverage. Generally, the lateral side falls, the palm touches the ground, the trunk tilts, the humeral shaft is highly abducted and the external rotation position, and the external force transmitted from the palm to the tibia can break the joint capsule. The anterior wall slides forward, causing dislocation of the shoulder joint; when the front of the shoulder joint is impacted, the humeral head can be broken backwards to break the joint capsule and cause dislocation of the shoulder joint. At this time, the excessive rotation of the humeral head can also cause the shoulder. Dislocation after joints.

an examination

Related inspection

X-ray examination of mammography

Traumatic anterior dislocation of the shoulder has a significant history of trauma, shoulder pain, swelling and dysfunction. The injured limb is elastically fixed in the mild abduction internal rotation, elbow flexion, and the affected side forearm is supported by the contralateral hand. The appearance is a "square shoulder" deformity, the shoulder peak is prominent, and the shoulder is empty. The humeral head can be touched under the armpits, under the condyles or under the collarbone. Mild abduction of the injured limb can not be close to the chest wall. If the elbow is attached to the chest, the palm cannot touch the opposite shoulder at the same time (Dugas sign, that is, the shoulder test is positive). The upper arm is placed on the outside of the upper arm to simultaneously contact the acromion and the external iliac crest (straight rule test).

The patient often used the sitting position, the head was biased to the injured side, the shoulder was drooping, the abduction was slightly abducted, the elbow was flexed, and the posture of the injured forearm was held with the hand on the side of the hand. The shoulder was flattened, the shoulder was prominent, and the wall was lowered. Square shoulder. During the examination, when the affected elbow is close to the chest wall, the affected side of the finger can not touch the contralateral shoulder, which the medical doctor called "Duga's sign positive." Local swelling and pain, under the condyle or under the collarbone can touch the humeral head, shoulder joint activity is limited. The main performance is:

1. General performance:

Traumatic anterior dislocation of the shoulder is mainly caused by shoulder pain, swelling of surrounding soft tissue, and limited joint activity. The contralateral hand is often used to support the forearm of the affected limb, and the head tends to have a shoulder to reduce activity and muscle traction and relieve pain. Swelling shoulders are swollen, painful, active and passive. The affected limb is elastically fixed in a light outreach position, often with a hand holding the arm, and the head and torso are inclined to the affected side.

2, local specific signs

1 Elastic fixation: The upper arm remains fixed in the mild abduction anterior flexion, and the movement in any direction will cause pain; Dugas sign positive: the elbow of the affected limb is close to the chest wall, and the affected hand cannot touch the opposite shoulder. Otherwise, the patient has placed To the opposite shoulder, the affected limb cannot be close to the chest wall.

2 Malformation: Observing the patient from the front, the shoulder loses its normal full and rounded shape, showing a "square shoulder" deformity, the distance from the shoulder to the upper iliac crest increases, the shoulder deltoid muscle collapses, and the shoulder is deformed. In the armpit, Under the condyle or under the collarbone, the displaced humeral head can be touched, and the joint is empty.

3 joint emptiness: in addition to the square shoulder deformity, palpation found under the shoulders of the emptiness, can reach the dislocated humeral head under the armpit, condyle or clavicle. The shoulder test is positive. When the affected side is leaning against the chest, the palm cannot be placed on the opposite shoulder.

Differential diagnosis

Differential diagnosis of shoulder test positive:

1. Dislocation after shoulder joint: Post-shoulder dislocation is less common. One of the reasons is that there is strong muscle group protection behind the shoulder joint, which is difficult to pull out backwards. Even after dislocation, it is easy to be due to the tensile stress of the posterior muscle group. Nano, so it is rare in clinical practice.

2, external humeral neck fracture: the external humerus neck is located 2 ~ 3cm below the anatomical neck, is the junction of the cancellous bone of the humeral head and the humeral bone cortical bone, it is prone to fracture. All ages can occur, and there are more elderly people.

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