MSK - Shoulder Exam

Question 1

How would you describe a MSK shoulder exam to a patient?

Answer 1

• Ive been asked to an examination of your shoulders . This will involved having a look , feel and move of the joint. You will have to expose your both shoulders and arms and the examiner will act as a chaperone today - Is this ok?

Question 2

What is the general layout of a shoulder MSK exam?

Answer 2

1) WIPE
2) ask about pain?
3) Look - gen inspection of bedside and shoulders
4) Feel (temp, palpate bony landmarks, joint line, muscles)
5) Move (external rotation, Internal rotation, elbow flexed external rot, abduction and adduction)
6) Function ( can you get hands behind head and back)
7) winged scapula?

Question 3

In an MSK shoulder exam what would you look for on general inspection?

Answer 3

1) bedside - analgesion, slings,
2) patient comfortable and well
3) obvious shoulder abnormalities such as winged scapula or assymetry
4) scars or swelling
5) muscle bulk of deltoid, supraspinatus and infraspinatus

Question 4

What would you feel for in an MSK shoulder exam?

Answer 4

1) temperature of the joint
2) Palpate bony landmarks:
- sternoclavicular joint
- clavicle
- acromioclavicular joint
- coracoid process
- biceps tendon
- scapula borders (spine, medial,inferior pole, lateral)
3) Palpate the joint line (ant and post)
4) muscle bulk of supraspinatus , infraspinatus and deltoid.

Question 5

how would you assess the active shoulder movements in an MSK exam?

Answer 5

Screen:

• hands behind head ( move elbows back)
• hands behind back (do circle motion

1) Flexion , extension
2) Abduction (palpate pole of scapula to assess proportion of movement of the glenohumeral joint (normal 0 - 150 ).
3) External rotation (arm at 90 degrees)
4) Internal rotation (feel highest point on back with thumb)

Question 6

How do you assess passive movements of the shoulder in an MSK exam?

Answer 6

1) Flexion
2) Extension
3) ext rotation
4) int rotation
5) abduct then allow to actively slowly adduct, if there is pain between 60 - 120 degrees then this is painful arc - there is supraspinatus tendinitis.

Question 7

What special tests do you so in a MSK shoulder exam?

Answer 7

1) Scarf test for acromioclavicular pathology

2) Rotator cuff
- Supraspinatus (abduct first 15 degrees against resistance - pain?)
- Infraspinatus / Teres minor (external rotation against resistance)
- Subscapularis - gerber’s lift off test - lift hands of back against resistance.

3) Bicep’s tendonitis
4) Winged Scapula
5) shoulder apprehension test

Question 8

What does a positive shoulder apprehension test indicate?

Answer 8

previous dislocation

Question 9

What causes a winged scapula?

Answer 9

long thoracic nerve lesion