Shoulder examination

Question 1

Introduction

Answer 1

Introduce yourself and identify the patient details- gain their consent
Infection control- wash your hands
Ask patient to remove their upper garments

Question 2

Procedure

Answer 2

Remember to examine both shoulders and compare one side with the other

Question 3

LOOK

Answer 3

From front, side and posterior aspects
Observe for any scars, swelling, erythema, muscle wasting or abnormal contours
Hands outstretched straight in front to assess for winged scapula

Question 4

FEEL

Answer 4

Palpate all aspects of both shoulders for any tenderness, swelling or warmth: bones and muscles
Around across girdle, AC joint, coracoid, borders and spine of scapula
Back of hand over anterior girdle for temperature

Question 5

MOVE

Answer 5

Active then passive moments
Flexion and extension (straight up as far as poss, straight back as far as poss)
Abduction and adduction (from sides up high as possible, then down across body)
Internal and external rotation- Elbows into sides, in across body and out

During passive moments- remember to feel for joint crepitus during flexion/ extension and stabilise the scapula during abduction

Question 6

SPECIAL TESTS

Answer 6

Assess important functional movements. Ask the patient to:

• Place their thumbs up their back and try to reach as high as possible
• Place their hands behind their head, with their elbows as far back as possible

NOTE- many conditions can cause shoulder pain (e.g pain radiating from the neck, gallbladder disease, cardiac pain) Depending on the circumstances you may want to perform other relevant clinical examinations