Musculoskeletal (Shoulder) Flashcards
What do you look for on inspection of the shoulder?
Ask patient to stand if possible and fully expose shoulder, inspect from front back and sides
From the front, compare both looking for: symmetry/swelling/deformity/bony prominence/ muscle wasting/scars/skin changes
From the back, compare both looking for: muscle bulk/scapula abnormalities/scars/skin changes
From the side, look for: posture
What do you look for on palpation of the shoulder?
Begin palpating from the front, working medial-lateral, do one side at a time
Temperature of the joints - using back of hands
Feel joints: Sternoclavicular joint, clavicle, acromioclavicular joint, acromion process, glenohumeral joint, spine of scapula, scapula - look for temp/pain/swelling
Feel muscles: deltoid, supraspinatus, infraspinatus, trapezius
How do you assess the range of motion of the shoulder?
Screening: Ask patient to put hands behind head and push elbows back as far as they will go (external rotation/abduction); ask them to put their hands behind their back (internal rotation/abd)
Active: flex elbow to 90 degrees and tuck into patient side and ask to rotate outwards (external rotation, first movement lost in frozen shoulder) and inwards (int rot); ask patients to raise arms in front and behind them (flex, ext - should be done independently); check painful arc (abd)
Passive: repeat above but with doctor manipulating body instead of patient
What is the painful arc and how do you assess it?
Ask patient to raise arm to the side with palm downwards up to vertical then lower
Observe from front and back for symmetry of scapula movement and any pain
A patient with a rotator cuff pathology will often exhibit pain from 60-120 degrees, may be alleviated upon repeating with palm up-facing
Pain only at the end of the movement (120-180 degrees) may indicate acromioclavicular joint arthritis
What else should you ask?
Can the patient dress themselves without difficulty?
Can they wash their own hair?
How do you perform a rotator cuff test?
Resisted active abduction (supraspinatus =first 15 degrees, deltoid = up to 90, trapezius + serratus anterior = over 90 degrees)
Resisted active external rotation (infraspinatus, teres minor)
Resisted active internal rotation (lift off test - subscapularis - back of their hand on their lumbar spine, push off against your hand)
How do you look for acromioclavicular pathology?
Place arm into forced adduction across the body at 90 degrees of flexion at the shoulder = the scarf test
Note any pain over the ACJ
How do you complete the examination?
Assess the neurovascular status of the limb (though will probably only have to state in the OSCE)
Thank the patient and request them to redress
Wash hands
(this is the same for all MSK examinations)
