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Shoulder Examination
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Inspection
- From the front
- prominent sternoclavicular joint
- prominent acromiclavicular joint
- From the side
- swelling of the joint
- From behind
- scapulae normally shaped and situated
- From above
- swelling of the shoulder
- deformity of clavicle
- asymmetry of supraclavicular fossae
Palpation
- anterior and lateral aspects glenohumeral joint
- upper humeral shaft and head via axilla
- acromioclavicular joint
Movement
- Abduction & Adduction - both arms noting:
- range of movement
- pain
- Flexion
- Extension
- Rotation screening
- place arm behind opposite shoulder blade
- ask patient to draw hand away from back
- place both hands behind neck
- compare two sides
- crepitus - - place hand over shoulder, abduct arm
Special tests
- Rotator cuff
- abduction and drop arm test- lift pt’s arm abduct and ext rotate, at 90 deg, release, if drops, +ve for supra and infraspinatus,
- teres minor & infraspinatus test
- Neer impingement sign- depress scapula, internally rotate arm , forced flexion, anterior pain subacromial , posterior pain internal impingement
- Hawkin’s test – rest your arm across the other shoulder, elbow flexed, internally rotate- - subacromial bursitis if +ve, 80 % sensitivity, 60% specificity
- Lift off test –subscapularis testing, check power
- Anterior glenohumeral instability
- apprehension test- patient supine, abduct arm ,add gradual ext rotation until pain or fear of subluxation
- Posterior glenohumeral instability
- apprehension test- supine, 1 hand support behind scapula, 90 dg flexion arm, adduct and int rotate with axial loading
- Inferior glenohumeral instability- arm by side, grab elbow and pull distally. if sulcus present under acromion +ve ( if unilateral, some ppl have both sides – not pathological)
- sulcus sign
- Biceps tendinitis & sup labral tear- speed test (weak test)- extend elbow, flexed arm to 90 deg then resistance from examiner
- Yergasson’s test – arm by side, palpate bicipital groove, resisted supination
- Integrity of the long head of biceps /subluxation
- Deltoid power
- Suprascapular nerve
- supraspinatus
- infraspinatus
- Long thoracic nerve
- lean with both hands against the wall
- Axillary nerve and NV status distally
Subscapularis Tear Tests | |||||
---|---|---|---|---|---|
Test | Sensitivity | Specificity | +LR | -LR | Kappa |
Bear hug test | 0.74 | 0.97 | 25 | -0.3 | - |
Napoleon test | 0.84 | 0.96 | 21 | -0.2 | - |
Liftoff test | 0.65 | 0.95 | 13 | -0.4 | - |
Internal Rotation Lag Sign | 1.0 | 0.5 | 2 | -0 | - |
Resources
Shoulder Examination by Dr Amanjeet Toor
References
Thank you to Dr Amanjeet Toor
Other general resources
- Cleland J, Koppenhaver S, Su J. Netter's orthopaedic clinical examination: an evidence-based approach: Elsevier Health Sciences; 2015.
- Wheeless III C. Shoulder: Physical exam. Wheeless’ textbook of orthopaedics Retrieved from http://www wheelessonline.com/ortho/shoulder_physical_exam. 2010.
- ↑ Takeda et al.. Diagnostic Value of the Supine Napoleon Test for Subscapularis Tendon Lesions. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2016. 32:2459-2465. PMID: 27349714. DOI.