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.
Obvious other joint disease
Compare contours of both sides: Level, symmetric AC outlines, squaring off.
Skin – Scars, swelling
Tenderness and swelling
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):
Abduction (90 deg)
Adduction (50 deg)
External rotation (60 deg)
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
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.