View of the Shoulder Girdle

An examination already begins during a patient's taking off, which is the best opportunity for a doctor to watch a functional restriction of movements, mainly during a pulling of clothes over his/her hand. During the examination deformities of contours of the shoulder girdle can be obvious, especially at serious states.

Deformities of the Shoulder Girdle Visible at Rest

1. a fracture of the clavicle or the humerus

2. bursitis which changes a contour of the shoulder when there is a bigger filling¹

3.  atrophy of muscles, distinctly more visible at neurological affections than at the affection of the rotator cuff² by rheumatoid processes. There occurs atrophy only at ruptures of the rotator cuff

4. a luxation of the shoulder joint

5. haematoma : often at eventual ruptures of muscles

6. arthrotic changes in the area of the sternoclavicular articulation

7. a luxation of the acromioclavicular articulation

Deformities of the Shoulder Girdle Visible during the Movement

1. a  lump of the arm during an active contraction of m. biceps at its rupture

2. a sticking out of the scapula during a press-up against the wall can occur in the case of a weakness of m. serratus anterior, f. e. caused by paresis of n. thoracicus longus³

3. an enlargement of the sternoclavicular articulation at the articular instability. The sternoclavicular articulation should be watched at maximal abduction. An excessive enlargement of this articulation shows a laxity of the sternoclavicular articulation and its ligamentous apparatus.

Co-ordination of the Movement and its Restriction during Complex Movements of the Shoulder Girdle

If we stand behind the patient, we can watch , except the extension of the movement, a scapulohumeral and scapulothoracal rhythm during the examination of complex movements of the limb⁴. The rhythm is in the case of a disorder, mainly glenohumeral articulation, violated, and at the elevation of the limb the patient compensates the disorder of motility by an excessive movement of the scapula, and so the extension of elevation does not have to be restricted at the first sight.

Presence of the Articular Instability

In the area of the shoulder girdle we find an instability mainly of the glenohumeral articulation. With regarding to its meaning, therefore the instability of the glenohumeral articulation is described independently. We can meet the same cause of the problems at the sternoclavicular and acromioclavicular joint.

¹But patient notices the oedema of the shoulder, and he/she talks about as a symptom even if quantity of the liquid is minimal, mostly with words: I think that my shoulder is swollen even if I cannot see anything.

²except ruptures of the rotator cuff

³so-called scapula alata