Prepare patient
- Introduction
- Position standing with upper limbs & upper chest exposed
General Principles of Joint Exam
- Check if any pain, then look, feel, move, measure & compare with other side, & assess function.
Look
- General inspection
- Obvious other joint disease
- Shoulders
- Compare contours of both sides: Level, symmetric AC outlines, squaring off.
- Skin – Scars, swelling
- Deltoid wasting
Feel
- Tenderness and swelling
Move
- Screening test:
- Patient touches other shoulder in front of neck, behind neck & behind back. Movements (stand behind rest one hand on shoulder and move patient’s elbow with other):
- Passive:
- Abduction (90 deg)
- Adduction (50 deg)
- External rotation (60 deg)
- Active
- Elevation (180 deg)
- Flexion (90 deg, 180 deg if scapula allowed to rotate)
- Internal rotation (90 deg) – patient places hand behind back with elbow at 90 deg
- Extension (65 deg)
- Note limitation, pain, crepitus
- Rotator cuff – painful arc often in just one plane Joint disease – all directions affected
- Neurological weakness – painless
Function
- Watch undress if possible
- Anterior stability – apprehension test
- Stand behind patient with one hand on shoulder, flex elbow to 90 and abduct, extend & ext rotate (“hand’s up” type pose) while pressing head of humerus anteriorly with thumb. Resistance if impending dislocation.
- Axillary nerve damage –
- loss of sensation over badge area of upper arm.