Upper limb exams: shoulder exam

Question 1

Initial approach:
- How should you position the patient?
- How to get adequate exposure?

Answer 1

Get them to stand up.
Explain it’s important you have full view of shoulder, are you able to remove your shirt?

Question 2

Feel:
What structures are you feeling for anteriorly?

Answer 2

Sternoclavicular joints
Clavicle
Acromioclavicular joints

Question 3

Feel:
What structures are you feeling for laterally?

Answer 3

Greater tuberosity
Lesser tuberosity
Intertubercular groove

Question 4

Feel:
What structures are you feeling for posteriorly?

Answer 4

Spine
Acromion process + subacromial space
Coracoid process
Inferior angle
Medial border of scapula

Question 5

What movements should you done?
What should you comment on?

Answer 5

Flexion
Extension
Abduction
Adduction
Internal rotation
External rotation

Absence or prescence of crepitus

Question 6

How many tests are there? What are their names?

Answer 6

8
Hawkin’s test
Neer’s test
Empty can test
Painful arc test
Resisted movements
Biceps function tests
Apprehension test
Apley scratch test

Question 7

Hawkin’s test: what does it look for?

Answer 7

Subacromial impingement
Full thickness rotator cuff tears, in particular supraspinatus tears

Question 8

What is subacromial impingement?

Answer 8

Rotator cuff tendons and subacromial bursa run through the subacromial space
Can become inflamed – rotator cuff tendonitis and subacromial bursitis
Impingement occurs when the acromia and tendons/bursa rub and cause pain

Question 9

Hawkin’s test: how to perform it?
What effect do these actions have?

Answer 9

Flex the arm 900
Flex the elbow 900
Put your inner arm on their outer shoulder (to stabilise the inner scapula)
Put your outer arm on their inner wrist; push the wrist inwards and down (to internally rotate the humerus)

Internally rotating the humerus drives the greater tuberosity under the coracoacromial arch, impinging the supraspinatus tendon

Question 10

Hawkin’s test: negative and positive test?

Answer 10

Negative test: no pain
Positive test: pain (upon internal rotation of humerus)

Question 11

Neer’s test: what does it test for?

Answer 11

Subacromial impingement syndrome

Question 12

Neer’s test: how to perform it?

Answer 12

Stabilise the scapula with one hand (ie. Hand on shoulder)
Pronate patient’s arm
Forward flex the arm as high as possible (to 1800)

Question 13

Neer’s test: negative and positive test?

Answer 13

Negative test: no pain reported
Positive test: pain reported

Question 14

Empty can test: what does it test?

Answer 14

Assesses supraspinatus muscle and tendon

Question 15

Empty can test: how to perform?

Answer 15

Flex arms and put in a V shape
Internally rotate the arms so that thumbs are facing down (like pouring an empty can)
Hold the wrists; push down and ask the patient to push back

Question 16

Empty can test: negative and positive test?

Answer 16

Negative test: no weakness or pain
Positive test: weakness or pain

Question 17

Painful arc: what does it test for?

Answer 17

Tests for subacromial impingement syndrome

Question 18

Painful arc: how to conduct?

Answer 18

Ask patient to do abduction
- No pain before 60 degrees, as deltoid is contracting and rotator cuff (supraspinatus) isn’t involved yet
- At 60-120, supraspinatus tendon becomes squished. After 120, no more compression/pain.

Question 19

Painful arc: negative and positive signs?

Answer 19

Negative sign: no pain at 60-1200 of abduction
Positive sign: pain occurs at 60-1200 of abduction

Question 20

Resisted movements: what movements do the following muscles perform?
- Supraspinatus
- Infraspinatus
- Subscapularis

Answer 20

• Supraspinatus: abduction of shoulder
• Infraspinatus: external rotation
• Subscapularis: internal rotation

Question 21

Resisted movement - supraspinatus
- How to conduct?
- Negative and positive signs?

Answer 21

Question 22

Resisted movement - infraspinatus
- How to conduct?
- Negative and positive signs?

Answer 22

Question 23

Restricted movement - subscapularis
- How to conduct?
- Negative and positive signs?

Answer 23

Question 24

Biceps function:
Biceps tendonitis test
- What does it test for?
- How to conduct it?
- Negative and positive tests?

Answer 24

Question 25

Biceps function:
Ruptured biceps test
- What does it test for?
- How to conduct it?
- Negative and positive tests?

Answer 25

Question 26

Apprehension test
- What does it test for?

Answer 26

instability of the glenohumeral joint; including joint capsule integrity

Question 27

Apprehension test: how to conduct?

Answer 27

Ask if they’ve had a shoulder injury before
Ask them to tell you right away if they feel their shoulder will pop out (and if they say so, stop immediately)
Abduct and externally rotate the arm (make L shape; pull forearm back towards you)
Stand behind the patient, push the thumb against the humeral head (make an anterior force).

Question 28

Apprehension test: negative and positive result?

Answer 28

Negative: not apprehensive that their glenohumeral joint will dislocate
Positive: apprehensive that their glenohumeral joint will dislocate.

Question 29

Apley scratch test: what does it test for?

Answer 29

Range of motion of glenohumeral joint
Potential rotator cuff muscle tears

Question 30

How to perform Apley scratch test?

Answer 30

Touch opposite shoulder in front
Touch opposite shoulder over
Touch opposite shoulder under

Question 31

Apley scratch test: what are negative and positive tests?

Answer 31

Negative test: able to complete these motions smoothly
Positive test: unable to complete these motions smoothly