Shoulder Examination

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 test performances [LOE 1b]

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.