Shoulder examination

Question 1

During the shoulder examination, what is involved in inspection of the shoulder?

Answer 1

Look for (both back and front):

• Erythema and swelling
• Deformities
• Scars
• Muscle wasting
• Symmetry (of the clavicle and scapula)

Question 2

What is involved in palpation of the shoulder during the shoulder examination?

Answer 2

• Palpate the clavicle, starting the sternoclavicular joint, moving towards the acromioclavicular joint, look for step deformities along the way (e,g, sign of clavicle fracture); palpate the acromion and coracoid processes
• Palpate the scapula, including the spine, the lateral and medial borders of the scapula, palpate the infraspinatus and the supraspinatus
• Palpate other muscles associated with the shoulder
  
  • Rhomboids
  • Superior trapezius
  • Teres major, teres minor
  • Latissmuss dorsi
  • Deltoids
  • Lateral pectoralis major and supero-lateral pectoralis minor

Question 3

What range of movement tests are important in the shoulder examination?

Answer 3

Apley’s scratch test = hand in front of neck to opposite scapula, hand behind neck to thoracic vertebrae, hand behind back to thoracic vertebrae

Active followed by passive movements (assessing for crepitus as well) = flexion and extension, abduction and adduction, internal and external rotation

Question 4

What special tests should be done in the shoulder examination?

Answer 4

Apprehension test (to test for GH joint stability/integrity)

Rotator cuff tests

• Supraspinatus = empty can test (resisted flexion with internal rotation at shoulder and extension at elbow)
• Infraspinatus = resisted external rotation with elbow flexed
• Subscapularis, teres minor = lift off test (resisted internal rotation)