Shoulder Examination

Question 1

What three questions to ask at start of exam

Answer 1

Dressing, washing hair and reaching into high cupboards

Question 2

Important things to ask before starting shoulder exam

Answer 2

Ask about pain, stiffness, tenderness, other systemic changes AND FUNCTION.

Question 3

Look for in shoulder exam

Answer 3

• Posture and symmetry
• Muscle wasting
• Scars or any skin changes
• Swelling
• Deformity

Question 4

Feel shoulder exam

Answer 4

• Temperature across shoulder joints
• Assess abnormalities or swelling in bony landmarks
• Muscle bulk in rotator cuff muscles
  Humerus, Clavicle, shoulder girdle, ACJ, Scapula

Question 5

Move shoulder exam

Answer 5

• Put patients hands behind back and watch from front and back
• Put hands behind your head
• Active before passive
• Flexion and Extension
• External rotation - elbows tucked into sides
• Abduction - presence of a painful arc?

Question 6

If pain arc between 120 and 180 with no relief on 180

Answer 6

acromioclavicular joint pathology

Question 7

If painful arc but relief further below or arms straight above

Answer 7

rotator cuff injury

Question 8

If painful and cannot raise arm above 90° then

Answer 8

DELTOID injury

Question 9

Pain below 90°

Answer 9

supraspinatus injury

Question 10

Resisted external rotation

Answer 10

Infraspinatus or teres minor

Question 11

Resisted internal rotatation

Answer 11

Subscapularis

Question 12

Shrug shoulders pathology

Answer 12

Trapezius

Question 13

ACJ test

Answer 13

Scarf test - forced abduction across body is painful

Question 14

Completion of shoulder joint

Answer 14

• Examine the cervical spine and elbow. When examining the elbow, you should use the schema ‘look, feel, move’.
• Assess the neurological and vascular status of the limb (In the OSCE, unless you are given specific instructions to perform this assessment, you should simply state to the examiner that you would do so).
• Thank the patient and request them to redress
• Wash your hands

Question 15

Sudden onset of intense shoulder pain with PE impossible

Answer 15

Acute Bursitis

Question 16

Painful resisted scapular elevation

Answer 16

Sternoclavicular problem

Question 17

Ddx of shoulder exam

Answer 17

Trauma
Frozen shoulder
ACJ dysfunction
Subacromial bursitis
Tendonitis
Polyarthropathies
Degenerative disease

Question 18

Abduction and or external rotation against resistance weak but not painful

Answer 18

Rotator cuff rupture

Question 19

C4 pain. Frontal flexion and adduction and internal rotation painful and restricted

Answer 19

Acromioclavicular problem