shoulder examination
TRANSCRIPT
THE ORTHOPAEDIC EXAMINATION
BASIC RULES
LOOK
FEEL
MOVE
SPECIAL TESTS
SHOULDER EXAMINATION
KNOWLEDGE….
“The eye doesn’t see what the mind doesn’t
know”
Know common shoulder problems…
Young – shoulder instability
Old – shoulder impingement, rotator cuff tear
TAILOR YOUR EXAMINATION TO WHAT IS
SUSPECTED – P.E IS NOT A SET
ROUTINE
LOOK
Adequate exposure! (No shyness in exams!)
Always look from front, side and back
Always search for:
• Deformities
• Swellings
• Wasting
• Scars
• Sinus
AXILLA :
ALSO PART
OF
SHOULDER!
FEEL
Do it in a sequence
SC joint → clavicle → AC joint → acromion
→ scapula spine
Ant and post glenohumeral joint line
Axilla
Also feel for warmth
MOVE
POINTS TO REMEMBER
Shoulder has 6 axis of movement
The normal anatomy of glenohumeral joint is
facing anteriorly by 15-20 degrees
ABDUCTION / ADDUCTION
Normal range: 0 – 160/180 degrees
Supraspinatus → deltoid → scapula muscles (trapezius / serratus anterior)
Painful arc
Scapulohumeral rhythm
FLEXION / EXTENSION
Normal range:
Flexion: 0 – 180
Extension: 0 – 40
Always remember the plane of
scapulohumeral joint!
EXTERNAL / INTERNAL ROTATION
Normal both are 0 – 90 degrees
Best to do with shoulder abducted – Why?
But beware of dislocatable shoulder!
SPECIAL TESTS
AIM OF TESTS
1) To detect impingement
AIM OF TESTS
2) To detect rotator cuff tear (specific muscles)
AIM OF TESTS
3) To detect shoulder instability
HOW TO DO
For impingement – by manually causing
impingement between humerus and
acromion
Neer’s impingement sign Hawkin’s test
HOW TO DO
For rotator cuff tear – motions and power of
each muscle must be tested
Jobe’s test -
Supraspinatus
External rotation test –
Infraspinatus / Teres
minor
HOW TO DO
Gerber’s lift off test
Tests for
Subscapularis
Napoleon’s test
HOW TO DO
For instability – to demonstrate the instability
Sulcus signShoulder apprehension test
MUST ENSURE THE SHOULDER IS NOT
DISLOCATED DURING EXAMINATION!!!
POINTS TO PONDER
P.E must be done with knowledge
It is NOT a set routine
Must be able to spot diagnosis even before
starting P.E
Your P.E is to prove the diagnosis by
searching for relevant positives
And to rule out other diagnosis by searching
for relevant negatives
THANK YOU