Examination Of The Shoulder

Question 1

1

Answer 1

Intro
Ask if any pain in the arm, shoulder or neck

Question 2

2

Answer 2

Inspection
Ask the patient to stand, if this is not possible then the patient may sit on a chair or the side of the couch/bed

With the shoulder fully exposed inspect from the front, side and back

Question 3

From the front compare the two shoulders looking for

Answer 3

-symmetry
-posture
-swelling
-deformity
-Bony prominence (sternoclavicular joint; acromioclavicular joint)
-muscle wasting (deltoid)
-scars
-any other skin changes (e.g. erythema)

Question 4

From behind inspect

Answer 4

-Muscle bulk (supraspinatus – above scapula wing, infraspinatus – below scapula wing; trapezius, rhomboids)
-Any abnormalities in the scapula
-Any scars or skin changes

Question 5

3

Answer 5

Using the back of your hand, assess the temp over the shoulder area

Question 6

4

Answer 6

Begin palpating from the front, work from medial to lateral. Palpate for increased temp, joint line tenderness, swelling and crepitus
-Sternoclavicular joint
-clavicle
-acromioclavicular joint
-acromion process
-glenohumeral joint
-spine of the scapula
-scapula

Question 7

5

Answer 7

Palpate the muscle bulk of
Deltoid
Supraspinatus
Infraspinatus
Trapezius

Question 8

6

Answer 8

Assess range of motion
Ask the patient to put their hands behind their head and push their elbows back as far as they can (external rotation, abduction)

Question 9

7

Answer 9

Ask the patient to put their hands behind their back (internal rotation, abduction) Look for any difficulty, limitation or pain on movement. Describe how far they can reach up the back.

Question 10

8

Answer 10

External rotation: Flex the elbow to 90° and tuck it into the patient’s side - then ask the patient to rotate the arm outwards. (This is usually the first movement
lost in a frozen shoulder)

Question 11

9

Answer 11

Internal rotation: Flex the elbow to 90° and tuck it into the patient’s side- then ask the patient to rotate the arm inwards.

Question 12

10

Answer 12

Flexion & Extension: Ask the patient to raise their arms in front and behind them.

Question 13

11

Answer 13

Abduction: check the painful arc

Ask the patient to raise their arm to the side, palm downwards, and then lower. Normal movement is up to 180°. Observe from both the front and behind for symmetry of scapula movement & pain. Assess glenohumeral movement and scapulothoracic movement.

If the patient has rotator cuff pathology, there is often pain from 60-120°, which may be alleviated by repeating with palm facing upwards. Pain only occurring at the end of the movement (120-180°) may indicate acromioclavicular joint (ACJ) arthritis.

Question 14

12

Answer 14

Assess passive range of motion

After testing active movement, passively test the range of external rotation, internal rotation, flexion, extension and abduction, palpating the shoulder joint for crepitus whilst doing so

Question 15

13

Answer 15

Function:
Ask the patient if they
-can dress themselves without difficulty
-can wash their own hair

Question 16

14

Answer 16

Completion

Examine the cervical spine and elbow. When examining the elbow, you should use the schema ‘look, feel, move’.

Assess the neurological and vascular status of the limb (In the OSCE, unless you are given specific instructions to perform this assessment, you should simply state to the examiner that you would do so)

Question 17

Specifics tests

Question 18

Which special test assesses the supraspinatus?

Answer 18

Resisted active abduction

Question 19

Which special test assesses the infraspinatus and teres minor?

Answer 19

Resisted active external rotation

Question 20

Which test assesses subscapularis?

Answer 20

Resisted active internal rotation

Question 21

What is the scarf test?

Answer 21

Place the arm into forced adduction across the body at 90° of flexion at the shoulder = “scarf test”. Note any pain or tenderness over the ACJ.

Acromio-clavicular joint pathology