Shoulder examination Flashcards
What is the introduction for a shoulder examination?
- Wash hands.
- PPE.
- Introduce self.
- Ask patient name and DOB.
- Explain examination.
- Gain consent.
- Offer a chaperone.
EXTRA STEPS:
- Ask patient to take off their top.
- Ask the patient if they have any pain in arm, shoulder or neck.
What comes after introduction?
Inspection (LOOK).
How is inspection done?
- Get patient to stand (if possible).
- Examine shoulder from the front, side and back. Assess symmetry, muscle bulk, deformity, scars etc.
What comes after inspection?
Palpation (FEEL).
How is palpation done?
- Assess temperature over the shoulder area.
- Palpate from the sternoclavicular joint along the clavicle, around the shoulder joint, and then the posterior shoulder/ scapula.
- Assess muscle bulk of deltoids, rotator cuff and traps. So both sides simultaneously as this allows symmetry to be assessed.
What comes after palpation?
MOVE (active).
How is active shoulder movement assessed?
First thing is compound movements:
- Hands behind head and push elbows back (abduction and external rotation).
- Hands behind back and reach as high as they can (abduction and internal rotation).
Next active isolation movements:
- External rotation.
- Internal rotation.
- Flexion/extension (raise straight arm in front and behind).
- Abduction (Raise arms outwards and upwards with palms downwards). Watch from behind to observe scapula movement.
NOTE: Pain in middle of movement is suggestive of rotator cuff pathology. Redo movement with palms upwards - this should reduce the pain if the pathology is rotator cuff.
What comes after active movement assessment?
- Assess passive movement.
How is passive shoulder movement assessed?
- Assess internal rotation, external rotation, flexion, extension and abduction all passively whilst FEELING THE SHOULDER JOINT FOR CREPITUS.
What comes after passive movement assessment?
- Functional tests.
How is function assessed?
Ask patient if they can:
- Wash their own hair.
- Dress themselves without difficulty.
What comes after functional assessment?
Special tests.
What are the special tests involved in assessment of the shoulder joint?
Supraspinatus - Resisted initial 15 degrees of abduction. Empty can test too.
Infraspinatus - Resisted external rotation.
Subscapularis - Place hand behind back, then attempt to lift the hand off the back (“lift off” test).
Scarf test - Place arm into adduction across the body.
What comes after special tests?
- Conclusion.
How is the shoulder examination concluded?
- Thank the patient for their time.
- Ask the patient to redress.
- Wash hands.
