Shoulder Examination

Question 1

What may causes asymmetry of the shoulder girdle?

Answer 1

Scoliosis, arthritis, fractures or dislocation

Question 2

What may cause deltoid wasting?

Answer 2

• Disuse atrophy

- Axillary nerve injury

Question 3

What may cause trapezius muscle asymmetry?

Answer 3

• Disuse atrophy

- Spinal accessory nerve lesion

Question 4

What may cause supraspinatus or infraspinatus asymmetry?

Answer 4

• Muscle wasting secondary to chronic rotator cuff tear

- Suprascapular nerve lesion

Question 5

What is scapular winging indicative of?

Answer 5

Ipsilateral serratus anterior muscle weakness, usually secondary to a long thoracic nerve injury

Question 6

Where is the sternoclavicular joint?

Answer 6

Between the sternum and clavicle

Question 7

Where is the clavicle?

Answer 7

Extends between the sternum and the acromion of the scapula

Question 8

Where is the acromioclavicular joint?

Answer 8

The joint between the acromion and the clavicle

Question 9

Where is the acromion?

Answer 9

A continuation of the scapular spine and the most superolateral bony prominence of the shoulder

Question 10

Where is the coracoid process of the scapula?

Answer 10

A small hook-like bony prominence located 2cm inferior and medial to the clavicular tip

Question 11

Where is the head of the humerus?

Answer 11

Located 1cm inferolateral to the coracoid process

Question 12

Where is the greater tubercle of the humerus?

Answer 12

Located slightly anterolateral to the head of the humerus

Question 13

Where is the spine of the scapula?

Answer 13

Running from the acromion towards the thoracic vertebrae

Question 14

How do you test external rotation and abduction of the shoulder joint together?

Answer 14

Ask the patient to put their hands behind their head and point their elbows out to the side

Question 15

How do you test internal rotation and adduction of the shoulder joint?

Answer 15

Ask the patient to place each hand behind their back and reach as far up their spine as they are able to

Question 16

What is the normal range of movement of active shoulder flexion?

Answer 16

150-180 degrees

Question 17

How do you test active shoulder flexion?

Answer 17

Ask the patients to raise their arms forwards until they’re pointing up towards the ceiling

Question 18

What is the normal range of movement of active shoulder extension?

Answer 18

40 degrees

Question 19

How do you test active shoulder extension?

Answer 19

Ask the patient to stretch out their arms behind them

Question 20

What is the normal range of movement of active shoulder abduction?

Answer 20

180 degrees

Question 21

How do you test active shoulder abduction?

Answer 21

Ask the patient to raise their arms out to the sides in an arc-like motion until their hands touch above their head

Question 22

What is the normal range of movement of active shoulder adduction?

Answer 22

30-40 degrees

Question 23

How do you test active shoulder adduction?

Answer 23

Ask the patient to keep their arms straight and move them across the front of their body to the opposite side

Question 24

What is the normal range of movement of active external rotation?

Answer 24

80-90 degrees

Question 25

How do you test active external rotation?

Answer 25

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

Question 26

What is the normal range of movement of active internal rotation?

Answer 26

The patient is able to reach to the level of T4-T8

Question 27

How do you test active internal rotation?

Answer 27

Ask the patient to place each hand behind their back and reach as far up their spine as they are able to

Question 28

How do you assess scapular movement?

Answer 28

- Ask the patient to abduct their shoulder whilst you simultaneously palpate the inferior pole

Question 29

What typically causes axillary nerve palsy?

Answer 29

Shoulder dislocation

Question 30

What are the clinical features of axillary nerve palsy?

Answer 30

- Loss of sensation over the lateral deltoid region - Deltoid muscle weakness - Biceps and brachial weakness

Question 31

What are the names of the tests which assess the supraspinatus?

Answer 31

Empty can test/Jobe's test

Question 32

What does the empty can/Jobe's test indicate?

Answer 32

Weakness and/or impingement of supraspinatus

Question 33

What does the painful arc test for?

Answer 33

Impingement of supraspinatus

Question 34

Between what degrees does impingement or supraspinatus tendonitis typically cause pain?

Answer 34

Between 60-120 degrees

Question 35

What does external rotation against resistance test assess the function of?

Answer 35

Infraspinatus muscle and teres minor

Question 36

What does pain on the external rotation against resistance test indicate?

Answer 36

Infraspinatus tendonitis

Question 37

What does external rotation in abduction test indicate?

Answer 37

Function of the teres minor muscle

Question 38

What is Hornblowers sign and what causes it?

Answer 38

- The inability to keep the arm in position while testing external rotation in abduction - Teres minor pathology or axillary nerve lesion

Question 39

What does Gerber's lift off test/internal rotation against resistance test?

Answer 39

Function of the subscapularis muscle

Question 40

What result of Gerber's test/internal rotation against resistance test indicate?

Answer 40

- Pathology of the subscapularis muscle e.g. tendonitis/tear - Subscapular nerve lesion

Question 41

What does the Scarf test assess the function of?

Answer 41

The acromioclavicular joint

Question 42

What does it indicate if a patient feels pain during the scarf test?

Answer 42

- Positive test | - Suggestive of acromioclavicular joint pathology e.g. osteoarthritis

Question 43

What exams/investigations should be carried out after a shoulder exam?

Answer 43

- Neurovascular examination of the upper limbs - Examination of the joints above and below (cervical spine and elbow) - Further imaging