Shoulder

Question 1

Special tests

Test rotator cuff

Answer 1

Supraspinatus
- Empty can test
- Arms flexed to about 70 degrees, a bit wider than shoulder 
width apart, thumbs pointed downwards
- Push down on patients forearms
• Infraspinatus/teres minor
- External rotation against resistance
• Subscapularis 
- Gerber’s lift-off test
- Hand behind back, held a couple or inches away from spine
- “Don’t let me push your hand back”

Question 2

Special tests

Impingement

Answer 2

• Hawkins-Kennedy Test

• Shoulder abducted to 90, elbow flexed to 90, palm facing down
• Rotate shoulder so that palm goes downwards
• Pain suggests supraspinatus impingement
  • Scarf test
• Ask patient to touch their opposite shoulder
• Can be reinforced by applying pressure on the elbow
• Pain suggestive of ACJ pathology/injury

Question 3

Shoulder abduction

Answer 3

Arms by sides, palms forward, thumb upwards, raise arms slowly
out to the sides until they are above the head
• Lower arc pain
- ~80-90 degrees
- Suggestive of supraspinatus impingement
• High arc pain
- >120 degrees
- Suggestive of ACJ injury/pathology

Question 4

Shoulder flexion

Answer 4

Raise hands above head

Question 5

Shoulder external rotation

Answer 5

Arms by sides, elbow flexed to 90º and fixed to side
• Rotate arm outwards
• Loss of external rotation common in frozen shoulder

Question 6

Shoulder internal rotation

Answer 6

Reach up your back as high as possible

Question 7

Shoulder extension

Answer 7

Bring arms back

Up to 60 normal

Question 8

Palpation of shoulder

Answer 8

SCJ
• Clavicle
• ACJ
• Acromion
• Borders of scapula
• Greater tubercle of humerous
• Coracoid 
• Biceps tendon
• Supra- spinatus, infraspinatus and deltoid muscles

Question 9

Shoulder power

Answer 9

Deltoid - axillary nerve

Question 10

Sensation of shoulder

Answer 10

Deltoid axillary nerve

Question 11

Vascular shoulder

Answer 11

Radial pulse

Question 12

Passive movement of shoulder

Answer 12

Only do it if pain or limitation on active movement

Question 13

Function of shoulder

Answer 13

Hands behind head
• Hands behind back
• Right hand touching left shoulder (and vice-versa)

Question 14

Shoulder inspection

Answer 14

Overall alignment
• Deformity - one shoulder often sits slightly higher than the other,
steps in clavicle, dislocation, winging of scapula (long thoracic
nerve injury)
• Scars - arthroscopy, shoulder surgery
• Wasting - trapezius (squaring of the shoulders), deltoid, triceps,
biceps, supraspinatus, infraspinatus
• Swelling - inflammation, bursitis
• Skin changes - erythema, bruising
• Don’t forget to check axilla