Shoulder exam

Question 1

What are you looking for on inspection in a shoulder exam?

Answer 1

From the front, side, and back:
- symmetry (scoliosis, dislocation, etc.)
- posture
- swelling (effusion, inflammatory arthritis)
- abnormal bony prominence (can indicate fracture)
- scars
- skin changes (erythema)
- winged scapula (long thoracic nerve injury)
- aids/adaptions (e.g. splints)

Question 2

What are you feeling for in a shoulder exam?

Answer 2

• Temperature (increased in septic or inflammatory arthritis)
• Palpate joint lines and bony prominences for tenderness, swelling, irregularities of sternum, clavicle, humerus, scapula

Question 3

What are the compound screening movements in a shoulder exam?

Answer 3

• Ask patient to put their hands behind their head and elbows out to side (external rotation and abduction)
• Ask patient to place their hands behind their back and reach as far up their spine as they are able (internal rotation and adduction)

Question 4

How do you asses movement in a shoulder exam?

Answer 4

Active:
- flexion (raise arm forwards to ceiling)
- extension (stretch arm straight behind)
- external rotation (elbows flexed at their side, move forearms outwards)
- internal rotation (elbows flexed at their side, move forearms inwards)
- abduction (raise arm to side until above head)
Passive:
- repeat movements passively while palpating shoulder joint for crepitus

Question 5

What are the special tests required in a shoulder exam?

Answer 5

• External rotation against resistance (tests function of infraspinatus and teres minor muscles)
• Internal rotation against resistance/lift-off test (tests function of subscapularis muscle)
• Empty can test (supraspinatus)
• Scarf test (tests function of acromioclavicular joint)
• Painful arc (pain between 60 - 120 degrees = rotator cuff pathology)

Question 6

How do you complete a shoulder exam?

Answer 6

• Examine the cervical spine and elbow joint
• Perform a neurovascular examination of the upper limbs