Shoulder Examination Flashcards
What may causes asymmetry of the shoulder girdle?
Scoliosis, arthritis, fractures or dislocation
What may cause deltoid wasting?
- Disuse atrophy
- Axillary nerve injury
What may cause trapezius muscle asymmetry?
- Disuse atrophy
- Spinal accessory nerve lesion
What may cause supraspinatus or infraspinatus asymmetry?
- Muscle wasting secondary to chronic rotator cuff tear
- Suprascapular nerve lesion
What is scapular winging indicative of?
Ipsilateral serratus anterior muscle weakness, usually secondary to a long thoracic nerve injury
Where is the sternoclavicular joint?
Between the sternum and clavicle
Where is the clavicle?
Extends between the sternum and the acromion of the scapula
Where is the acromioclavicular joint?
The joint between the acromion and the clavicle
Where is the acromion?
A continuation of the scapular spine and the most superolateral bony prominence of the shoulder
Where is the coracoid process of the scapula?
A small hook-like bony prominence located 2cm inferior and medial to the clavicular tip
Where is the head of the humerus?
Located 1cm inferolateral to the coracoid process
Where is the greater tubercle of the humerus?
Located slightly anterolateral to the head of the humerus
Where is the spine of the scapula?
Running from the acromion towards the thoracic vertebrae
How do you test external rotation and abduction of the shoulder joint together?
Ask the patient to put their hands behind their head and point their elbows out to the side
How do you test internal rotation and adduction of the shoulder joint?
Ask the patient to place each hand behind their back and reach as far up their spine as they are able to
What is the normal range of movement of active shoulder flexion?
150-180 degrees
How do you test active shoulder flexion?
Ask the patients to raise their arms forwards until they’re pointing up towards the ceiling
What is the normal range of movement of active shoulder extension?
40 degrees
How do you test active shoulder extension?
Ask the patient to stretch out their arms behind them
What is the normal range of movement of active shoulder abduction?
180 degrees
How do you test active shoulder abduction?
Ask the patient to raise their arms out to the sides in an arc-like motion until their hands touch above their head
What is the normal range of movement of active shoulder adduction?
30-40 degrees
How do you test active shoulder adduction?
Ask the patient to keep their arms straight and move them across the front of their body to the opposite side
What is the normal range of movement of active external rotation?
80-90 degrees
How do you test active external rotation?
Ask the patient to keep their elbows by their sides flexed at 90 degrees whilst they move their forearms outwards in an arc-like motion
What is the normal range of movement of active internal rotation?
The patient is able to reach to the level of T4-T8
How do you test active internal rotation?
Ask the patient to place each hand behind their back and reach as far up their spine as they are able to
How do you assess scapular movement?
- Ask the patient to abduct their shoulder whilst you simultaneously palpate the inferior pole
What typically causes axillary nerve palsy?
Shoulder dislocation
What are the clinical features of axillary nerve palsy?
- Loss of sensation over the lateral deltoid region
- Deltoid muscle weakness
- Biceps and brachial weakness
What are the names of the tests which assess the supraspinatus?
Empty can test/Jobe’s test
What does the empty can/Jobe’s test indicate?
Weakness and/or impingement of supraspinatus
What does the painful arc test for?
Impingement of supraspinatus
Between what degrees does impingement or supraspinatus tendonitis typically cause pain?
Between 60-120 degrees
What does external rotation against resistance test assess the function of?
Infraspinatus muscle and teres minor
What does pain on the external rotation against resistance test indicate?
Infraspinatus tendonitis
What does external rotation in abduction test indicate?
Function of the teres minor muscle
What is Hornblowers sign and what causes it?
- The inability to keep the arm in position while testing external rotation in abduction
- Teres minor pathology or axillary nerve lesion
What does Gerber’s lift off test/internal rotation against resistance test?
Function of the subscapularis muscle
What result of Gerber’s test/internal rotation against resistance test indicate?
- Pathology of the subscapularis muscle e.g. tendonitis/tear
- Subscapular nerve lesion
What does the Scarf test assess the function of?
The acromioclavicular joint
What does it indicate if a patient feels pain during the scarf test?
- Positive test
- Suggestive of acromioclavicular joint pathology e.g. osteoarthritis
What exams/investigations should be carried out after a shoulder exam?
- Neurovascular examination of the upper limbs
- Examination of the joints above and below (cervical spine and elbow)
- Further imaging
