Shoulder Exam

Question 1

Introduction?

Answer 1

1. introduce yourself
2. confirm patient details
3. explain procedure
4. gain consent
5. ask if they have pain

Question 2

Inspection from front?

Answer 2

1. head and neck posture
2. symmetry of shoulders
3. deltoid wasting
4. alignment of shoulder girdle
5. scars

Question 3

Inspection from sides?

Answer 3

scars

Question 4

Inspection from behind?

Answer 4

1. scars
2. deltoid wasting
3. alignment of shoulder girdle
4. trapezius wasting
5. paravertebral muscle wasting
6. scoliosis
7. winged scapula

Question 5

Inspection of winged scapula?

Answer 5

ask the patient to reach out in front of them
- testing for long thoracic nerve injury

Question 6

Feel of shoulder joints?

Answer 6

1. assess and compare joint temperature
2. palpate shoulder girdle
   - from sternoclavicular joint > clavicle > acromioclavicular joint > coroid process > head of humerus > greater tuberosisty of humerus
3. palpate borders of the spine of the scapula

Question 7

Movement of shoulder joints?

Answer 7

1. shoulder abduction and external rotation with elbow flexion
   - hand behind your head and push your elbows back
2. shoulder internal rotation
   - put hands behind your back and reach up your back as far as you can
3. active shoulder flexion
   - reaqch up as high as you can
   - normal : 150-180 degrees
4. active shoulder extension
   - reach behind you as far as you can
   - normal : 40 degrees
5. active shoulder abduction
   - reach out to the sides and up
   - normal : up to 180 degrees
6. active shoulder adduction
   - bring arms down and across the chest
   - normal : 30 - 40 degrees
7. active shoulder external extension
   - normal: 80-90
8. active shoulder internal rotation
   - normal 80-90
9. assess the movement of the scapula
   - touch their back and ask them to move their arm out and towards the ceiling
   - assess degree and smoothness of scapular movement

Question 8

Special tests?

Question 9

Empty can test?

Answer 9

assess for weakness and impingement of supraspinatus

Question 10

The painful arch?

Answer 10

assess for impingement of supraspinatus

Question 11

External rotation against resistance?

Answer 11

assesses for tendonitis or a tear of infraspinatus

Question 12

Internal rotation against resistance?

Question 13

Further investigations?

Answer 13

examination of joint above and joint below