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Examination of the shoulder

Examination of the shoulder

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Leo S. L. Chong
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18 views27 pages

Examination of the shoulder

Examination of the shoulder

Uploaded by

Leo S. L. Chong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Examination of the

Shoulder
Remember the basic outline
 Always take the HISTORY of the complaint
 LOOK at the joint
 FEEL the anatomical landmarks
 MOVE the joint
 Apply SPECIAL TESTS
 Check the NEUROVASCULAR status
 Examine joints above and below
Anatomical features

 3 bony components
Skeletal anatomy
Anatomical features
 3 bony components
 Attachment to the axial skeleton through
muscles
 Movement at the
 Gleno-humeral joint
 Acromio-clavicular joint
 Sterno-clavicular joint
 Scapula movement on the chest wall
Skeletal anatomy
Shoulder joint
 Extensive range of
motion
 Stability from
 Ligamentous structures
 Muscular and tendonous
structures
 Shallow bony fossa
deepened by the
fibrocartilagenous
labrum
Muscular components
 Muscles stabilising the gleno-humeral joint
 Rotator cuff
 Supraspinatus
 Infraspinatus
 Subscapularis
 Teres minor
 Biceps tendon
 Muscles moving the scapula
 Muscles moving the humerus
Anterior muscles
Posterior muscles
Look
 From the front
 Prominence of the SC joint
 Deformity of the clavicle
 Prominence of the AC joint
 Deltoid wasting
 From the side
 Joint swelling
 Scarring
 Bruising
Look
 From behind
 Normally sized and situated scapulae
 Scapula winging
 Loss of muscle bulk
 Loss of muscle contours
 From above
 Asymmetry
 Swelling
 Loss of normal fossae
Feel
 Start at the SC joint and move over the clavicle
to the AC joint
 Palpate the anterior and lateral aspects of the
gleno-humeral joint
 The humerus can be felt in the lateral wall of
the axilla
Feel
 Examine the acromion
 Continue over the spine of scapula and the
muscles
 Always examine both shoulders
Move
 Abduction/adduction
 Flexion/extension
 Internal/external rotation
 Circumduction
Abduction
 Note difficulties in
initiation
 Observe both arms and
check the smoothness of
movement
 Check active and
passive ROM
Abduction
 Pain in the upper arc
tends to occur with OA
of the AC joint
 Midrange impingement
is associated with
bursitis
 Pain in the lower arc
tends to reflect rotator
cuff injuries
Painful arc
Special tests

 Check long thoracic nerve power by looking


for winging of the scapula
 Assess joint stability
 Assess rotator cuff integrity
 Impingement
 Assess biceps integrity
Impingement
Shoulder instability
Joint stability
 Inferior draw ‘sulcus sign’
 Anterior subluxation
 Abduction and external rotation “apprehension test”
with thumb posteriorly and fingers anteriorly over
humeral head
 Posterior subluxation
 Internal rotation adduction flexion and push posteriorly
Inferior draw
Rotator cuff tear
Rotator cuff integrity
 Supraspinatus (anterosuperior cuff)
 Resisted abduction with arms by side
 Flexion of the pronated and internally rotated arm
 Infraspinatus/teres minor (posterior cuff)
 Resisted external rotation with arms by sides elbows
flexed
 Subscapularis (anteroinferior cuff)
 Push examiners hand away from ‘hand behind back’
position
Biceps tendon
 Examine for bruising
 Muscle belly falls medially
 Pain felt when the supinated arm is flexed
against resistance
 Characteristic bulge when the elbow is flexed
Biceps tendon rupture

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