Shoulder Exam

Question 1

4 joints found in the shoulder region

Answer 1

gleno-humeral, acromioclavicular, sternoclavicular and scapulothoracic articulation

Question 2

The muscles of the rotator cuff

Answer 2

supraspinatus, subscapularis, infraspinatus and teres minor

Question 3

impingement syndrome

Answer 3

occurs when the supraspinatus, subacromial bursa or other structures get pinched between the humeral head and the acromion (most common cause of shoulder pain)

Question 4

What generally happens with an inferiorly directed overload of force to the shoulder joint?

Answer 4

AC (acromioclavicular) joint disruption

Question 5

What generally happens with a medially directed overload force to the shoulder joint?

Answer 5

fracture in the middle of the clavicular S-curve

Question 6

What do you palpate for the shoulder exam?

Answer 6

AC joint, clavicle and SC joint

Question 7

Function of AC (acromioclavicular) joint:

Answer 7

allows for the final 10-20 degrees of shoulder abduction and forward flexion

Question 8

Strength tests for the shoulder

Answer 8

Empty can test (supraspinatus), full can test (abduction, also supraspinatus), external rotation test (infraspinatus), Lift off test…single hand parade rest (subscapularis)

Question 9

Special tests

Answer 9

Impingement: Neer’s, Hawkins
Instability: Apprehension, Relocation (if Apprehension test is positive)
AC Joint test: AC cross chest adduction (scarf) test

Question 10

Neer’s Impingement Test

Answer 10

Fully pronate arm and flex at the shoulder against resistance. Tests for the impingement of rotator cuff tendons under the coracoacromial arch.

Question 11

Hawkin’s Test

Answer 11

Elevate shoulder to 90 degrees while keeping elbow flexed at 90 degrees. Support the arm then internally rotate the humerus. Pain with the maneuver suggests subacromial impingement or rotator cuff injury.

Question 12

AC cross chest adduction (scarf) test

Answer 12

Flex arm and shoulder to 90 degrees. Patient crosses arm over opposite shoulder. Examiner may further passively adduct. Pain in AC joint is a positive test.

Question 13

Apprehension test

Answer 13

With patient supine, abduct shoulder while arm is externally rotated with concominant anterior pressure to the humerus. Instability with this maneuver suggests anterior instability.

Question 14

Relocation test

Answer 14

Reduce external rotation until sense of apprehension resolves (to be completed with positive apprehension test)