Shoulder joint
Shoulder joint
EXAMINATION
ANATOMY OF SHOULDER
Shoulder joint consist of
Glenohumeral joint
Acromio clavicular joint
Sub acromial space
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.
the back.
The hand is raised off the back by maintaining or increasing internal rotation of
preventing it.