Shoulder

Question 1

How should you start the examination?

Answer 1

Wash hands
Introduction
Identification
Consent
Exposure

Question 2

What should you ask before starting?

Answer 2

Do you have any pain?

Question 3

WHat do you look for when inspecting from the front?

Answer 3

Symmetry
Posture
Swelling
Deformity
Muscle wasting
Scars
Skin changes

Question 4

What do you look for when inspecting from behind?

Answer 4

Muscle bulk
Scapula abnormalities
Scars and skin changes

Question 5

How do you palpate at the front?

Answer 5

Medial to lateral

Question 6

What two ways should you palpate?

Answer 6

Back of hand (temp)

Normally for swelling, joint line tenderness

Question 7

Where do you initially palpate for temp?

Answer 7

Shoulder area

Question 8

What bone landmarks should you palpate for?

Answer 8

Sternoclavicular joint
Clavicle
Acromioclavicular joint
Acromion process
Glenohumoral joint (ant and post)
Spine of scapula
Scapula

Question 9

What muscles should you palpate?

Answer 9

Deltoid
Supraspinatus
Infraspinatus
Trapezius

Question 10

Where does the supraspinatus lie?

Answer 10

Above scapula wings

Question 11

Where does the infraspinatus lie?

Answer 11

Below scapula wings

Question 12

What is the screening examination for the shoulder?

Answer 12

Patient to put hands behind back, push elbows back (external rotation and abduction)
Patient to put hands behind their back (internal rotation, abduction)
How far can they reach hands up behind back

Question 13

How do you assess rotation?

Answer 13

Flex patients elbow to 90
Fix to side
Ask to rotate outwards
Repeat with inwards

Question 14

How do you assess flexion and extension?

Answer 14

Ask patient to raise arms in front and behind

Question 15

How do you assess abduction?

Answer 15

Patient to raise arms from side, palms down
Observe from in front and behind
Observe symmetry of scapula movement

Question 16

What will alleviate pain on abduction in rotator cuff injury?

Answer 16

Repeat with palms facing upwards

Question 17

Pain at what degree of movement suggests rotator cuff pathology?

Answer 17

60-120

Question 18

Pain at what degree of movement suggests acromioclavicular joint arthritis?

Answer 18

120-180

Question 19

What should you remember to do when assessing passive ROM?

Answer 19

Palpate shoulder for crepitus

Question 20

How do you assess shoulder function?

Answer 20

Do you have any problems dressing

Do you have any problems washing your hair

Question 21

What are the special tests for rotator cuff injury?

and which muscles

Answer 21

Resisted active abduction (supraspinatus)
Resisted active external rotation (infraspinatus, teres minor)
Resisted active internal rotation (subscapularis)

Question 22

How do you perform resisted active internal rotation? (lift off test)

Answer 22

Patient places hand on back (dorsum of hand on mid lumbar spine)
Lift dorsum of hand from spine
Positive is if they can’t

Question 23

What is the speicial test for acromio-clavicular pathology?

Answer 23

Place the arm into forced adduction across body with 90 flex in the elbow
Any pain or tenderness over ACJ

Question 24

How do you complete the exam?

Answer 24

Examine cervical spine and elbow

Neuro and vasc status of the limb

Question 25

What do you do at the end of the exam?

Answer 25

Thank patient
redress
wash hands
present