SHOULDER EXAMINATION

the scapula is offset 30 degrees from the frontal plane -- this is called the scapular plane

Acromioclavicular joint

Coracoacromial ligament: controls anterior and posterior translation of the lateral clavicle
Coracoclavicular ligament: controls vertical stability; restrains superior and anterior displacement Acromioclavicular ligament: provides stability across the joint; restrains posterior translation and displacement of the clavicle

Glenohumeral joint

Capsular ligaments: joins the glenohumeral joint capsule anteriorly, inferiorly, and posteriorly
Coracohumeral ligament: provides stability superiorly, preventing superior translation

Rotator Cuff

Supraspinatus: abducts the humeral head and acts as a humeral head depressor Infraspinatus: externally rotates and horizontally extends the humerus Subscapularis: internally rotates the humerus Teres minor: externally rotates and extends the humerus

Subscapularis

Conditions
Tumors/swellings Nonunions Instability Subacromial impingement Rotator cuff rupture SLAP Lesions

History
Pain/instabilty/both Decreased ROM Dominant hand Occupation Trauma Childhood history

General examination
Prominent veins Neck viens/swellings Chest movements Fingers trophic changes General condition

CHEST EXAMINATION

Shoulder examination
LOOK TOUCH MOVE MEASURE

Inspection
Attitude Front Side Back

Inspection

Front
Chest

wall Pect major Clavicle/recess AC joint alignment Deltoid contour Any other swellings

Side
Deltoid AC

joint Wasting of cuff muscles Swellings

head of humerus Scapula Ant chest wall

Back
Swellings Muscles

= wasting Scapula alignment AC joint Deltoid Interscapualar region

Above
Shoulder Spine

alignment

swellings

Palpation

Temperature Tenderness Swellings Bony points

Clavicle Acromion Humeral head Coracoid AC joint Scapula

Movements
Flexion Extension Internal rotation External rotation

abduction

Measurements
Arm length Arm span:height

Special tests

Apley scratch test

Patient touches superior and inferior aspects of opposite scapula

Loss of range of motion: rotator cuff problem Subacromial impingement Supraspinatus tendon impingement Rotator cuff tear Acromioclavicular joint arthritis

Neer's sign Arm in full flexion Hawkins' test Drop-arm test Cross-arm test

Forward flexion of the shoulder to 90 degrees and internal rotation Arm lowered slowly to waist Forward elevation to 90 degrees and active adduction

Spurling's test
Apprehensi on test

Spine extended with head rotated to affected shoulder while axially loaded
Anterior pressure on the humerus with external rotation

Cervical nerve root disorder

Anterior glenohumeral instability

Relocation test

Posterior force on humerus while externally Anterior glenohumeral rotating the arm instability

Sulcus sign

Pulling downward on elbow or wrist

Inferior glenohumeral instability

Yergason test Elbow flexed to 90 degrees with forearm pronated

Biceps tendon instability or tendonitis

Speed's maneuver

Elbow flexed 20 to 30 degrees and forearm supinated

Biceps tendon instability or tendonitis

"Clunk" sign Rotation of loaded shoulder from extension Labral disorder to forward flexion

Special Tests - Instability

Sulcus sign

Special Tests Instability

Gerber-Ganz Anterior Drawer Test & Jerk test

Special Tests - Instability

Anterior apprehension sign

Special Tests - Instability

Relocation test

Apprehension

Special Tests - Impingement

Neers sign Hawkins sign Jobes sign

Special Tests - Impingement

Neers sign

Special Tests - Impingement

Hawkins test

Special Tests - Impingement

Jobes test

Special Tests - Rotator Cuff

External rotation lag sign (ERLS) Hornblowers sign

Infraspinatus

/ teres minor

Internal rotation lag sign (IRLS) Liftoff test Subscapularis Zaslavs internal impingement test

Special Tests - Rotator Cuff

External rotation lag sign (ERLS) Infraspinatus / teres minor

Special Tests - Rotator Cuff

Internal rotation lag sign (IRLS) Liftoff test Subscapularis

Special Tests - Rotator Cuff

Belly Press test

Special Tests - Rotator Cuff

Zaslavs internal impingement test

Special Tests - Biceps

Speeds test Yergasons test

Special Tests - Biceps

Speeds test

Special Tests - Biceps

Yergasons tests

Special Tests SLAP Lesions

OBriens Test Compression / rotation test Pain Provocation test

Special Tests SLAP Lesions

OBriens Test

Special Tests SLAP Lesions

Compression / rotation test

Special Tests SLAP Lesions

Crank test

Special Tests SLAP Lesions

Kiblers anterior slide test

Ac joint cross arm test

Point tenderness over AC joint

Scarf test

Finally
Neurological examination Hand functions Pulses Other shoulder Same elbow

SPINE