CLIN MSK Shoulder Exam

Question 1

Process of MSK Shoulder Examination

Answer 1

1. HH
2. Greet pt
3. Introduce yourself
4. Identify pt
5. Explanation of examination & confidentiality
6. Discuss exposure – shoulders should be fully exposed (upper body exposed to the waist with bra/crop top on for female pts).
7. Obtain consent
8. Position the pt
9. Ask whether the pt is comfortable
10. Ask the pt if they are in pain or experiencing any discomfort before the exam.
11. General Inspection
12. Look – from front, sides & behind
13. Feel (normal joint first then joint of complaint)
14. Move – pt standing up
15. Special Tests
16. Thank pt
17. Redress
18. Report findings
19. Ask if any questions for pts
20. HH

Question 2

Process of General Inspection

Answer 2

a. Aids – specific to exam (e.g., casts/sling)
b. Posture
c. Pain/discomfort
d. ‘Noting body habitus’

Question 3

Process of Look

Answer 3

Symmetry
b. Scars
c. Rashes
d. Bruising
e. Erythema/redness
f. Swelling
g. Deformity
i. Valgus – away from the midline
ii. Varus – towards the midline.
h. Muscle wasting
i. Abnormal bone alignment
i. Dislocation – loss of contact btw joint surfaces
ii. Subluxation – displaced part of the joint surfaces remain partly in contact.
j. Posture
k. Contour

Question 4

Process of Feel

Answer 4

a. Skin warmth – w back of fingers
i. Active synovitis – swollen & slightly warm joint
ii. Infection
iii. Crystal arthritis (e.g., gout).
b. Tenderness
i. Fibromyalgia – tenderness present over muscles
ii. Inflammation – tenderness elicited over the margins of a joint
c. Synovitis – soft & spongy swelling
d. Effusion – fluctuant & mobile (can be made to shift within the joint)
e. Bone swelling – hard & immobile (suggesting osteophyte formation/subchondral bone thickening).
f. Bony landmarks – check both sides of pt
i. Sternoclavicular joint
ii. Clavicle (collarbone)
iii. Acromion
iv. Acromio-clavicular joint
v. Coracoid (bend elbow and externally rotate)
vi. Deltoid muscle
vii. Greater tuberosity (arm back)
viii. Biciptal groove (bend elbow and externally rotate)
ix. Lesser tuberosity
x. Spine of scapula
xi. Supraspinatus
xii. Infraspinatus
xiii. Medial & lateral borders of scapula

Question 5

Process of Move

Answer 5

a. Active
i. Abduction 180
ii. Adduction 50
iii. Flexion 180
iv. Extension 65
v. External rotation 65
vi. Internal rotation 90 w reach up and measured spinal level (scapula spine @ T3)
b. Passive – comment on presence/absence of crepitus (be aware in presence of fracture)
i. Abduction 90 – anchor scapula
ii. Adduction 50
iii. Flexion 180
iv. Extension 65
v. External rotation 65 – ensure elbow in
vi. Internal rotation 90

Question 6

Special Tests for Shoulder

Answer 6

a. Apley Scratch Test
b. Impingement Tests – Supraspinatus tear
i. Hawkins-Kennedy Test
ii. Neers Test
iii. Painful Arc Test
c. Apprehension Test – check pt Hx of dislocation
d. Resisted Movement Tests
i. Empty Can Test – Supraspinatus tear
ii. Biceps Test – Bicep tendon tear
iii. Lift-off Test – Subscapularis tear
iv. External Rotation Test – Infraspinatus & Teres Minor Tear