Shoulder Joint exam summary

Question 1

look at skin

Answer 1

scars

erythema

Question 2

look at soft tissue

Answer 2

swelling

muscle wasting eg deltoid/scapular muscles

Question 3

look at bone

Answer 3

deformity eg clavicular deformity or winging scapulae [get pt to do standing press-up against wall]

Question 4

feel skin

Answer 4

temp

Question 5

feel soft tissue

Answer 5

swelling
tenderness
acromioclavicular joint tenderness possible OA
tenderness around greater tuberosity humerus possible impingement

Question 6

feel bone

Answer 6

tenderness

deformity

Question 7

move active and passive movement ROM

check pain throughout
eg arc of pain with abduction = classic sign impingement
unable to hold the arm in abduction = weakness due to possible supraspinatus tear

Answer 7

Flexion 180
Extension 50
Abduction 180
Lateral rotation 60
Medial rotation - thumb to inferior border scapula

Question 8

move - resisted movement

Answer 8

check rotator cuff muscle strength/ reproduction of pain on resisted movements of shoulder
flexion/extension, adduction/abduction, medial/lateral rotation,
eg resisted lateral rotation - elbow by side, forearm in mid-position, resist movement at wrist of forearm laterally

Question 9

special tests

Answer 9

rotator cuff impingement/ Jobe’s test - empty can test
scarf test
instability tests
apprehension test

Question 10

rotator cuff impingement

Answer 10

if palpated tenderness around greater tuberosity and arc of pain with active abduction and pain reproduced on resisted abduction then do…

Question 11

Jobe’s test - empty can test

Answer 11

position arm
abducted to 90
horizontally adducted 30
medially rotate arm
so it looks like you are emptying an imaginary can
resist further abduction of upper limb resist at wrist joint

Question 12

if patient has swelling over AC joint area/ poniting specifically to pain over the area, do the scarf test

Answer 12

cross arm adduction of shoulder

place patients hand over their opposite shoulder as if you are positioning a scarf over that shoulder

Question 13

if pt complains of pain with overhead activity or hx of shoulder subluxation/dislocation do instability tests eg sulcus test…

Answer 13

distract humerus out of glenoid cavity gently by applying downward traction at the elbow joint

Question 14

if hx of trauma or subluxation/dislocation, do apprehension test…

Answer 14

arm held at 90 abduction, slowly laterally rotate arm while checking pt’s face for signs of apprehension