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Shoulder Examination: Difference between revisions
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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 | |||
{| class="wikitable sortable" | {| class="wikitable sortable" |
Revision as of 20:35, 21 July 2020
This article is a stub.
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
- ↑ 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.