Shoulder Examination

From WikiMSK

This article is a stub. Please help WikiMSK by expanding it.

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][1]
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 Wheelers 2010.


  1. 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.