Shoulder Examination
When examining the shoulder, you should follow the mnemonic, Inspect, Palpate and ROM
Positioning and Draping
The patient could be examined sitting or standing.
Patient should be exposed to the waist, exposing the shoulders.
Look for any:
masses, scars, lesions
atrophy/hypertrophy
muscle bulk and symmetry
signs of inflammation: erythema, swelling, warmth, pain, deformity
signs of trauma
Bony alignment
Inspect the patient's shoulders from the front and the back looking for any abnormal contours such as:
Prominent distal clavicle (AC separation)
Shoulder dislocation (squaring of the shoulder)
Popeye muscle (proximal biceps tendon rupture)
Scapular winging (thoracic nerve injury)
Palpate the shoulders for temperature
Bony prominences and alignment looking for deformities, tenderness
- throughout palpation, look at the patient for any reaction, such as pain which would be the sign for pathology
Palpate from the sternoclavicular joint along the clavicle to the acromioclavicular join, then to the glenohumeral joint and palpate the subdeltoid bursa
While shaking hands with the patient, palpate the greater tubercle of the humerus and the tendon of the biceps muscle which lies within the biceps groove (medial to the tubercle)
- Tenderness would signify biceps tendonitis
Palpate along the scapular spine in the back, and on the muscles around the scapula and over the scapula for tenderness and irregularities.
This should be done, by yourself and asking the patient to perform what you are doing, “Now, do what I do”
Active ROM
Patient should have no limitations in ROM, should be 180 degrees. If the patient does not have 180 degress, complete active ROM and go onto passive ROM examination.
Arm raise with straight arms
Forward flexion – arms at side palms facing back, raise arms straight in front of you over your head. If patient stops at 90 degrees, impingement sign
Extension – arms at side, palms facing backwards, raise arms as far backwards as possible
Abduction – arms at side palms touching thighs or legs, raise arms from your side to over your head. If patient stops at 90 degrees, this is a sign of rotator cuff damage or rotator cuff bursitis.
External rotation – hands behind head with elbows pointed out or just raise hand in an L fashion, like a right turn while riding a bike or driving.
Internal rotation – place hands behind back and touch opposite scapula with fingers or make an opposite L, like a bicycle or car stopping sign.
Passive ROM
This can be done while you palpate for any crepitus (grinding feeling or sound) on ROM on the glenohumeral joint, where the shoulder joint is.
Test patient strength of shoulder.
Shrugs, forward flexion, abduction, and external rotation all against resistance.
Special shoulder tests are done if there is any problem or abnormality on range of motion.
Patient starts with arms straight over head, and begins to lower them slowly to his or her side. If the patients shoulders “shifts or drops” at the 90 degree mark, this is a positive Drop Test, which identifies shoulder damage.
Patient has his or her arm abducted and externally rotated, you press on the back of the patients shoulder. Watch to see if the patient is apprehensive. If this is so, it is a sign of previous shoulder dislocations.
Anterior dislocations are about 90% of dislocations and the patient complains about pain, squaring of shoulder, positive apprehension test. The shoulder is abducted and externally rotated.
Posterior dislocations, the shoulder is adducted and internally rotated. The 3 mains causes of posterior dislocations are the 3E’s – epileptic seizures, ethanol intoxication and electrocution.
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