Shoulder Examination

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.

Wash hands