examination of the shoulder

please note that this examination is MSK exclusive.

flow of events

1. GIEP
2. wash hands
3. inspection
4. palpation
5. movement of joint
6. special tests

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I will skip the GIEP and hand washing

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upon inspection, you may want to see the following

• any redness over the shoulder - indicative of any inflammation or soft tissue injury
• any scars, wounds, soft tissue damage etc
• any bone deformities - sometimes the shoulder may look obviously assymetrical due to dislocations etc
• symmetry - look at muscle mass etc. muscles may atrophy if there is any nerve paralysis.

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upon palpation, you may start with;

• temperature - compare both sides. a higher temperature may suggest inflammation, a lower temperature at the more distal periphery may suggest disruption of blood vessels (e.g. due to closed fracture of humerus etc)
• tenderness - look at patient's face while palpating lightly in the shoulder area.
• muscle mass - there may be some significant muscle mass wasting in periphiral nerve damage, but not of major importance at this point in MSK.

then move on to;

• palpate the;

1. Sternoclavicular joint
2. clavicle
3. acromioclavicular joint
4. coracoid process
5. greater tubercle of humerus
6. lesser tubercule of humerus
7. the insertion of biceps tendon at intertubucular groove
8. acromium
9. spine of scapula

while looking at patient's face for any tenderness. - LOOK for a Mirror in the consultation room so that you can comfortably palpate and look for pain at the same time.

compare with other shoulder when applicable.

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movement (active first) - if movements are bilaterally full on active, passive not required.
to save time, you could ask the patient to do passive till possible ROM, than move limb passively.

6 movements

• flexion
• extension
• abduction
• adduction
• external rotation
• internal rotation

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special test

ask patient to press onto the wall - winging of scapula observed with serratus anterior nerve paralysis.
serratus anterior is innervated by long thoracic nerve. (serratus anterior functions to push scapula forward)

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Semester 7-9 material

there are several presentations of shoulder which has characteristic findings.

• instability
• sports injury / MVA
• rotator cuff injury
• dislocation with reduction
• apprehension test - bend shoulder in "flexing biceps" manner, push the shoulder from the posterior aspect with thumb, while the other 
• anterior and posterior drawer test
• sulcus sign - With the arm straight and relaxed to the side of the patient, the elbow is grasped and traction is applied in an inferior direction. With excessive inferior translation, a depression occurs just below the acromion. The appearance of this sulcus is a positive sign
• middle aged shoulder
• pain in shoulder while doing overhead movements
• nerve impingement in the 
• wasting of muscle in the supraspinatus
• drop-arm sign
• subscapularis - resistance to "bitch slap" motion
• empty can test
• infraspinatus - external rotation resistance 
• elderly shoulder
• adhesive capsulitis (frozen shoulder)
• global restriction of Range of movement. 
• osteoarthritis
• not very common in the east. 
• similar to frozen shoulder
•