MSK - Shoulder Examination

Question 1

VIVA

A patient presents with a winged scapula. Which nerve is most likely to be damaged?

Answer 1

Long thoracic nerve
This nerve controls the serratus anterior muscle and when damaged leads to winging of the scapula
Scapular winging may also be caused by damage to the dorsal scapular neve, which innervates the rhomboid muscles, or the spinal accessory nerve which innervates the trapezius muscle.

Question 2

VIVA

What are the four rotator cuff muscles?

Answer 2

Subscapularis
Teres minor
Supraspinatus
Infraspinatus

Question 3

VIVA

Please discuss the management options for adhesive capsulitis

Answer 3

NSAIDS, e.g. ibuprofen. Remember to always consider the use of a proton pump inhibitor (PPI) for stomach protection with prolonged use of NSAIDs.
Corticosteroid injections such as cortisone
Physiotherapy to stretch and strengthen the shoulder
Surgical options may include joint manipulation under anaesthetic, arthrographic distension, surgical release of the glenohumeral joint capsule

Question 4

VIVA

What is shoulder dystocia and which palsies may complicate this?

Answer 4

Shoulder dystocia is when one or both of a babies shoulders gets stuck behind the mothers pubic bone during vaginal delivery. Complications may include:
Erb’s palsy (most common): occurs when the nerves within the upper brachial plexus are damaged (C5-C6). It causes a loss of sensation and paralysis of the arm. The affected arm is characteristically rotated medially, and the forearm is extended and pronated.
Klumpke’s palsy: occurs when the nerves within the lower brachial plexus are damaged (C8-T1). This can affect the muscles in the hand and wrist, and sometimes forearm.

Question 5

Common shoulder pathology?

Answer 5

Question 6

Complications of anterior dislocation of the shoulder (95% of dislocations are anterior)

Answer 6

Question 7

Describe impingement syndrome

Answer 7

Question 8

Describe frozen shoulder

Answer 8

Question 9

Describe the shoulder apprehension test

Answer 9

Best done with pt supine ABduct shoulder 90°, flex elbow 90°, externally rotate shoulder Stabilise pt’s elbow with one hand Force further external rotation with other hand ‘Apprehensive’ reaction to this = positive test

Question 10

Describe Hawkins test

Answer 10

Flex shoulder 90°, flex elbow 90°, internally rotate shoulder
Stabilise pt’s elbow with one hand
Force further internal rotation with other hand
Pain in shoulder = positive test

Question 11

Describe Jobe’s test

Answer 11

“Gladiator position
Force shoulder ADduction against resistance from pt Pain / difficulty = positive test

Question 12

Desribe Gerber’s lift-off test

Answer 12

Hand behind back, dorsum resting against mid-lumbar spine Stand behind pt Apply light pressure to pt’s outward-facing palm “Push your hand straight backwards, off your back”
Pain / difficulty = positive test

Question 13

Describe resisted external rotation test

Answer 13

Arms by sides, elbows flexed to 90° Ask to externally rotate shoulders whilst you oppose them Pain / difficulty = positive test

Question 14

Which rotator cuff is tested with the Jobe’s/empty can test?

Answer 14

Supraspintatus

Question 15

Which rotator cuff is tested with Gerber’s lift-off test?

Answer 15

Subscapularis

Question 16

Which rotator cuff is tested with resisted external rotation?

Answer 16

Teres minor + Infraspinatus

Question 17

Which shoulder functions should you test?

Answer 17

Both hands behind head = Washing hair, dressing

Both hands up to mouth = Eating

Both hands down to bottom = Cleaning after toilet