P2: Shoulder Physical Examination

Question 1

what are you looking for in the observation part of the physical examination

Answer 1

• Swelling, wasting, deformity, balance, asymmetry, tremor, gait.
• Observe the person as a whole then more locally where you think the issue is. This might guide your assessment.
• Present symptoms.

Question 2

explain the functional demonstration part of a shoulder physical examiination

Answer 2

If possible, ask the patient to give a demonstration of an activity which is an issue for them.

Ask them why it is an issue for them/ what have they already told you?

Question 3

how should you test active range of motion in a shoulder physical examination

Answer 3

• Flexion
• Extension
• Abduction
• Adduction
• Internal rotation
• External rotation
• Horizontal flexion
• Combined movements (Hand behind back)

Stiffness?

Normal range?

Quality of movement?

Pain?

Altered biomechanics?

Question 4

how should you test pasisve range of motion in the soulder physical assessment

Answer 4

• What movements can you do for the patient?
• Compare with the opposite joint or what is considered normal.
• Shoulder PROM testing:
  
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Internal rotationExternal rotationHorizontal flexion

Does the AROM = PROM? If not, why?

Question 5

why might passive ROM be greater than active ROM

Answer 5

due to pain or weakness

Question 6

what does it mean if both passive and active ROM are limited

Answer 6

can be varied including joint pathology or bony abnormalities.

Question 7

how would you test resisted movemnts during a shoulder physical examination

Answer 7

• This could be static (isometric) testing, where the joint is in a particular position and doesn’t move.
• Resisted movement could also be tested through full available joint range or within a specific range of movement.
• This may be guided by the patient’s problem and your findings so far.

Question 8

how would you palpate during a shoulder physical examination

Answer 8

Palpation of the relevant structures which may include bones, joints and the surrounding tissues.

Question 9

what do you include in a simple problem list

Answer 9

A basic problem list may contain the following;

• Symptoms - Note if symptoms intermittent or constant, Note how symptoms affect the patient’s function and life.
• Movement and Strength - What active or passive movements were restricted, symptomatic or increased/decreased symptoms. We may record that an active movement was restricted but the same passive movement was full range. This would start to build a reasoning process. We may record weakness in movements and what the patient felt was causing the weakness e.g. pain or just couldn’t do.
• Palpation - Note palpation findings.