Exam - Shoulder

From CambridgeNotes

Look

  • Front: wasting; deformity
  • Side and above: swelling of joint
  • Back: scapula symmetry, prominence (winging?)

Feel: (from back)

  • Palpate cervical spine; palpate clavicle, acromioclavicular joint, spine of scapula, glenohumeral joint, humerus – tender? warm? Crepitus (degenerative joint disease)?

Move: active vs. passive: reduced active suggests neurological or muscular pain

  • Abduction: difficulty initiating suggests major cuff tear; painful arc (70o-120o) suggests cuff impingement
  • Adduct and internal rotation “undo bra” (Apley scratch test)
  • Abduct and external rotation “brushing your hair”
  • Forward flexion (165o), backward extension (60o)

Special tests: (provocation)

  • Impingement, rotator cuff tendonitis, sub-acromial bursitis
    • Feel sub-acromium: pain if tendonitis or bursitis
    • Neers test: one hand on patients scapula, other grasps their forearm; internally rotate arm; gently flex arm to position over head; pain suggests impingement
    • Bursitis or tendonitis? Steroid helps former!
  • Acromioclavicular joint: feel joint and ask patient to move arm across chest
  • Test rotator cuffs (SITS): “empty beer can test” (supraspinatus); external rotation (infraspinatus and teres minor); internal rotation (subscapularis)
  • Test for unstable glenohumeral joint: abduct arm to 90 degrees and externally rotate while pushing humerus anteriorly
  • Adhesive capsulitis (“frozen”) limits all movements

Neurovascular

  • Sensation over regimental badge; radial pulses
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