examination of the shoulder

Look

· exposure

· respect

clues

· splint

· sling

from front

Deformity

· head and neck alignment

· shoulder height

· arm rotation

Skin

Contour

Swelling

· SC jt

· clavicle

· AC jt

· biceps (rupture long head)

Wasting

· deltoid

· trapezius

· arm

from side

· turn affected side towards you

Contour

Wasting

· pectoral contour

from back

· turn patient away from you

Deformity

· scapular symmetry

· height

· winging

Contour

Wasting

· supraspinatus

· supraspinous fossa

· infraspinatus

· infraspinous fossa

· trapezius

· triceps

Feel

· ask patient “where is it painful ?”

from front

· stand beside patient

Bony prominences

· SC jt

· clavicle

· AC jt

· scapular spine

Soft tissue

· supraspinous fossa

· ganglion

· osteochondroma

· infraspinous fossa

· lateral subacromial

· tenderness

· cuff defect

· anterior

· anterior capsule

· biceps tendon

Move

from front

Active, passive, power

Abduction

Active

· elevate both arms

· in coronal plane

· comment on

· initiation

· range (170%)

· rhythm

· arc of pain

Passive

· if not full, passive to 180^o

· comment on

· active vs passive

· observe arm lowering

· comment on

· arc of pain

· drop arm

Rhythm

· go behind patient

· control scapula with one hand

· elevate arm with other hand

· comment on amount of GH range

Power

1. deltoid

· arm by side

· resisted elevation

2. biceps

· Speed’s test

· resisted elevation with forearm supinated

· assess pain at long head of biceps

3. supraspinatus

· stress test

· in plane of scapula

· 30^o forward from coronal

· humerus internally rotated

· flex elbow to demonstrate

· resisted elevation at 90^o

Forward elevation

Active

· both arms raised forward

· comment on

· range

· ability (trick movements)

External rotation

Active

· elbows flexed to 90^o and arms by side

· start with arms forward

· rotate arms outwards (75^o)

Passive

· if not full, passive

Power

· patient’s arm forward

· stabilise elbow with your hand

· resist external rotation

from behind

· turn patient away from you

Extension

Active

· both arms raised backward

Internal rotation

Active

· ask to run thumb up spine

· mark good and compare bad

· tip of scapula (T2)

· blade of scapula (T4)

· angle of scapula (T7)

Power

· Gerber’s lift-off test

· put dorsum of patient’s hand on buttock

· resisted lift-off

Trapezius

Power

· resisted shoulder shrug

Special tests

Impingement

· stand to side of patient

· to see expression

Neer’s impingement sign

· push down on scapula with one hand

· passively elevate arm with other hand

Neer’s impingement test

· mention how to do

Hawkin’s impingement sign

· forward flex elbow to 90^o

· internally rotate and adduct arm

sit patient down

· on edge of couch

Instability

Sulcus sign

· in front of patient

· hands in lap

· pull down on elbow

· one at a time

· look for sulcus

Anterior drawer

· behind patient

· stabilise shoulder girdle with one hand

· thumb on spine of scapula

· forefinger on coracoid

· translate humeral head forward with other hand

Posterior drawer

· translate humeral head backward

lie patient supine

Apprehension

Anterior apprehension

· shoulder abducted and elbow flexed 90^o

· externally rotate shoulder

· look for apprehension

Jobe test

· push proximal humerus backwards

· note increased ER without apprehension

Other

circulation

· radial pulse

cephalad joint

· neck ROM

concealed

· axilla

collagen

· ligamentous laxity