A site for medical students - Practical,Theory,Osce Notes

Drooping of the shoulder

How to detect the drooping of shoulder?
Ask the patient to stand with the face away from the examiner
  • Identify the level difference of the tips of both shouders
  • Distance between the inferior angle of scapula and the midspinal line is noted
  • Note the prominence of the inferior angle of the scapula
  • If any two of the above are positive the patient has a drooped shoulder
  • In drooping the following findings are noted
  • Lower end of scapula is at a lower level
  • Spine - scapular distance is reduced
  • Medial border of scapula is more prominent on the affected side
Causes of drooping
  • Fibrosis
  • Collapse
  • Trapezius paralysis
Mechanism of drooping in Fibrosis
It is due to decreased expansion of the lung producing disuse atrophy of the muscles & irreversible bone changes.
Minimum time for drooping to develop in fibrosis is 6 months
Mechanism of drooping in Collapse
Drooping is due to disuse atrophy,it is partially reversible
This is due to volume loss of the lung
Drooping takes only 6 weeks in collapse whereas it takes 6 months in fibrosis because the lung function is totally lost acutely in collapse and gradually in fibrosis
Drooping correctable on stooping forward is called as pseudodrooping
Causes are
  • Congenital scoliosis 
  • Pleurisy-Due to muscle spasm.
  • Empyema-Due to toxic myositis
Drooping vs Pseudodrooping
Drooping                                                                    Pseudodrooping
Convexity to the opposite side of lung disease        Convexity may to be either side
Not correctable on stoopirfg forwards or walking    Correctable on stooping forwards or walking
Causes of Reversible drooping
  • Pleurisy
  • Empyema
  • Collapse with removal of obstruction
Causes of Irreversible drooping 
  • Fibrosis