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Shoulder joint

The document outlines the anatomy and examination techniques for the shoulder joint, including the glenohumeral and acromioclavicular joints, as well as the rotator cuff muscles. It details inspection, palpation, movement assessments, and various tests for diagnosing shoulder conditions such as impingement and rotator cuff tears. Additionally, it describes specific tests for assessing AC joint problems and stiff shoulder conditions.

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raveendrannarayanath
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9 views23 pages

Shoulder joint

The document outlines the anatomy and examination techniques for the shoulder joint, including the glenohumeral and acromioclavicular joints, as well as the rotator cuff muscles. It details inspection, palpation, movement assessments, and various tests for diagnosing shoulder conditions such as impingement and rotator cuff tears. Additionally, it describes specific tests for assessing AC joint problems and stiff shoulder conditions.

Uploaded by

raveendrannarayanath
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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SHOULDER JOINT

EXAMINATION
ANATOMY OF SHOULDER
Shoulder joint consist of
Glenohumeral joint
Acromio clavicular joint
Sub acromial space

The rotator cuff muscles are


supraspinatus
subscapularis
teres minor
infraspinatus
INSPECTION

Anterior side
Posterior side
Lateral
Overhead
Axillary

ANTERIOR SIDE
Deltoid
Atrophy
Pain at insertion site- mostly referred from
rotator cuff pathology; rarely due to
deltoid tendinitis
POSTERIOR SIDE Scapula
Position
High- Sprengel’s
Spine
Fossae
Supraspinatus & infraspinatus
atrophy

Borders of scapula–
lateral
superior

Vertebral
PALPATION
Tenderness
Swelling
Palpable gap in muscles
Acromioclavicular joint
Coracoid process
Subacromial bursa
Biceps tendon
MOVEMENTS
Active
Passive
Resistive
FORWARD FLEXION:0-160°/180°
EXTENSION:0-45°
ABDUCTION:0-180
ADDUCTION-0-45
EXTERNAL ROTATION- 0-45°
INTERNAL ROTATION -0-55°
TESTS
Appley’s scratch test
Patient attempts to touch the opposite scapula thus testing abduction & ER and
adduction & IR Good screening test for ROM assessment
SPECIAL TESTS
IMPINGEMENT:
Painful arc syndrome
In abduction arc of motion
patient feels pain in the range 60- 120°.

O’Brien test
The patient flexes the arm to 90°
with the elbow fully extended and then adducts the arm
10-15° medial to sagittal plane.
The arm is then maximally internally rotated
and the patient resists the examiner's downward force.
Hawkins-Kennedy Test
patient sitting with arm at 90° forward elevation and elbow flexed to
90°.
Examiner then quickly moves the arm into internal rotation.
+ve = Pain located to the sub-acromial space Subacromial impingement,
rotator cuff tendinitis
Neer Impingement Sign
Examiner performs maximal passive forward flexion with internal rotation
whilst stabilizing the scapula.
+ = Pain located to the sub- acromial space or anterior edge of acromion
Subacromial impingement of supraspinatius & anterior part of
infraspinatus
Neer’s Impingement Test
Examiner after eliciting impingement sign,
injects local anesthetic soln. to subacromial
space.

Disappearance of pain is diagnostic


ROTATOR CUFF TEAR
Inability to abduct or flex foreward
Atrophy of supra & infraspinatus fossae

Empty can test - for supraspinatus


ER at arm at side with elbow flexed- for infraspinatus
Lift off test/ abdominal compression test – for
subscapularis
Drop Arm sign
External rotation lag sign
Supraspinatus “Empty
Can Test
Pt attempts to elevate the arms against resistance
with arms at 90° abduction in a plane 30° anterior true coronal plane
and full IR (thumb pointing downward) with elbows extended.
Positive = supraspinatus tear
Infraspinatus & Teres minor
Patient’s arms at the sides with elbows flexed to 90,
attempts to do ER
Subscapularis
1. Lift off test/ Gerber’s test
Patient standing with hand behind back with the dorsum of the hand resting on

the back.

The hand is raised off the back by maintaining or increasing internal rotation of

the humerus and extension at the shoulder.

Inability = subscapularis tear/ dysfunction


Subscapularis
2.Abdominal compression test
Patient attempts to press the hand down against abdomen with examiner

preventing it.

Useful when IR restricted.

Inability = subscapularis tear/ dysfunction


Drop Arm sign
Examiner abducts patient’s shoulder to maximum. After warning the
patient, examiner releases pt’s arm & asks him to lower the arm back to
the side.
Pt able to lower the arm part way & then suddenly loses control- arm
drops suddenly to the side.
Indicates large rotator cuff tear
Also seen in axillary nerve palsy
External rotation lag sign
Pt’s arm is externally rotated maximally and released-
arm rotates internally spontaneously (passive ER>active ER).
Seen when subscapularis is intact but infraspinatus & teres minor
is torn
AC JOINT PROBLEMS
Cross chest adduction test
Pt. elevates the affected
arm to 90°
then actively adducts it
STIFF SHOULDER
Restriction of all range of motion, esp- Abduction & ER
Pain on attempted movements
Blessy
Ardra

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