Orthopaedics

Shoulder Examination

Shoulder Examination
Inspection
Palpation
Range of motion
Active and passive

Neurovascular Exam

Inspection

Skin
Scars
Symmetry
Swelling
Atrophy
Hypertrophy
Scapular winging

Palpation
All bony prominences around
shoulder girdle (AC joint)
Muscles and soft tissues including
deltoid
rotator cuff muscles
trapezius
biceps tendon in groove

Range of Motion
Compare active and passive motion, both
sides
Seven planes of motion should be examined
and documented
forward elevation (150-180 considered normal)
external rotation atside
Abduction
internal rotation to vertebral height (T4-T8
considered normal)
internal rotationat 90 degrees abduction

Neurovascular Exam
Sensation
check dermatomes of following nerves

axillary
musculocutaneous
medial Brachial/Antebrachial Cutaneous
median
radial
ulnar

Motor
Deltoid, Biceps, Triceps, Extensor Pollicis Longus, Flexor
Digitorum Profundus, Dorsal Interossei

Vascular
brachial, radial, ulnar artery pulses

Special Tests
Neer Impingement Sign
indicative ofimpingementas well as many other
causes of shoulder pain/focal abnormalities
(stiffness, OA, instability, bone lesions); note you
must have full range of motion for "positive" finding.

technique
use one hand to prevent motion of the scapula while
raising the arm of the patient with the other hand in
forced elevation (somewhere between flexion and
abduction) eliciting pain (positive test) as the
greater tuberosity impinges against the acromion
(between 70-110)

Special Tests
Hawkins Sign
positive withimpingement

technique
performed by flexing shoulder to 90,
flex elbow to 90, and forcibly internally
rotate driving the greater tuberosity
farther under the CA ligament. test for
impingement.

Special Tests
Jobes Test
tests for supraspinatus weakness and/or
impingement

technique
abduct arm to 90, angle forward 30
(bringing it into the scapular plane), and
internally rotate (thumb pointing to floor).
Then press down on arm while patient
attempts to maintain position testing for
weakness or pain.

Special Tests
Apprehension and Relocation
positive test if the patient experiences the
sensation of instability

technique
have the patient lie supine.Apprehension test
performed by bringingthe arm in 90 degrees of
abduction and full external rotation and patient
experiences sense of instability. Relocation test
performed by placing examiner's hand on humeral
head applying a posterior force on the humeral
head. Patient will experience reduction or
elimination of sense of instability.

 Questions?