MSK Shoulder Exam

Question 1

What is the first step?

Answer 1

Introduce self
Ask patient’s name and DOB
Explain examination and gain consent

Question 2

What do you do after introducing yourself?

Answer 2

General inspection of the joint
Front
Side
Back
Both arms

Question 3

What do you do after inspecting the joint?

Answer 3

Feel the temperature of the joint

Question 4

What do you do after feeling the joint temp?

Answer 4

Palpate

Sterno-clavicular joint
Clavicle
Acromio-clavicular joint
Coracoid process
Humeral head
Tuberal tuberosity
Borders of the scapula

Question 5

What do you do after palpation of the joint?

Answer 5

Active movements

Compound movements
External rotation and abduction
Internal rotation and adduction

Flexion
Extension
Abduction
Adduction
External rotation
Internal rotation

Palpate scapula whilst patient abducts their shoulder

Question 6

What do you do after assessing active movements?

Answer 6

Passive movements

Flexion
Extension
Abduction
Adduction
External rotation
Internal rotation

Question 7

What do you do after assessing passive movements?

What does is assess for?

Answer 7

Empty Can Test

Ask patient to lift arms up and forwards , and then pretend to empty a cup

Supraspinatus tendinopathy or impingement

Question 8

What do you assess after the empty can test?

What does it assess for?

Answer 8

Painful Arc

Abduct patient’s arm for them to their head and then ask them to slowly adduct it to their side

Supraspinatus tendinopathy or impingement

Question 9

What do you assess after the Painful Arc test?

What does it assess for?

Answer 9

Ask patient to externally rotate their arm against your resistance

Infraspinatus Tendinopathy
and Teres minor Tendinopathy

Question 10

What do you assess after external rotation against resistance?

What does it assess for?

Answer 10

Gerber’s lift-off test

Ask patient to place arm behind back and push against your hand, one at a time

Subscapularis pathology or Subscapular nerve damage

Question 11

What do you assess after Gerber’s lift-off test?

What does it assess for?

Answer 11

Scarf test

Ask patient to flex shoulder to 90 degrees and place hand on opposite shoulder, apply resistance to patients elbow

Ask if any pain

Assesses for acromioclavicular joint pathology e.g osteoarthritis

Question 12

What further tests would you perform?

Answer 12

Neurovascular examination of the upper limbs.
Examination of the joints above and below (cervical spine and elbow joint).
Further imaging if indicated (e.g. X-ray and MRI).