Shoulder Examination

In video: Dr. Vinnith Pullavarayar Kavinraj Tang Yun Jan Videoed by Shavitha Pooja LOOK Anterior: Shoulder asymmetry Deformity ( eg. clavicle malunion ) Muscle wasting Swelling Skin changes ( scar, erythema, wound ) Inspect medial to lateral, from sternum → clavicle → acromion Midclavicular deformity : clavicular fracture Distal clavicle protrusion: AC joint subluxation Lateral: Scars Signs of inflammation Deltoid wasting Posterior: Scapulae Wasting of infra and supraspinatus: grooving above and below scapula Ask patient to push wall and see if there is winging of scapula ( serratus anterior muscle ) FEEL Palpate: Palpate from sternum → Claivcle → acromion Access warmth, tenderness, swelling Palpate coracoid process Palpate acromion process Palpate spine of scapula Palpate medial border of scapula Tenderness over: Acromioclavicular joint: OA Greater tuberosity: impingement or rotator cuff injury MOVE: Start with active and passive Movements include flexion ( 180 ), extension (50 ), abduction ( 180 ), adduction Painful arc syndrome ( pain from 60 - 120 degree abduction ) Cannot initiate abduction - supraspinatus tear Abduction should be accessed from posterior to look at scapula movement External rotation is done with patients elbow always in contact with body. This is to avoid abduction Don't forget to look for crepitus in passive movement ( OA ) External rotation most restricted in frozen shoulder. It is also first restricted in glenohumeral joint arthritis Interal rotation done by asking patient to put thumb at the back as high as possible. Normal range to at least reach inferior border of scapula Gerber's Lift off test Patients hand at the back, trying to lift off the back against resistance Looks for Subscapular strength ( rotator cuff ) Belly press test Elbow kept anterior to arm to minimize extension. Patient internal rotates arm as you give resistance. Looks for subscapular strength Infraspinatus and Teres minor strength Against resistance with external rotation Supraspinatus strength 30 degree flexion and abduction SPECIAL TEST Jobes test ( impingement. Also called empty can test ) Cross arm test / scarf test : positive in OA Drawer test Hawkin test : Impingement Dr. Vinnith