Shoulder Examination

Question 1

State the 7 stages to the shoulder examination

Answer 1

1. Introduction
2. Inspection
3. Palpate
4. Move
5. Special tests
6. Neurovascular assessment
7. Close examination/further investigations

Question 2

What should you do in the introduction stage of your shoulder examination?

Answer 2

• Wash hands
• Introduce yourself
• Gain conset
• Position pt
• Expose pt
• Offer chaperone
• Ask if any pain

Question 3

What position do you want your pt in for shoulder exam?

Answer 3

• Initially standing

Question 4

How do you want the pts exposed for shoulder examination?

Answer 4

Remove top clothing to expose pt’s shoulders fully

Question 5

What should you do in the inspection stage of your shoulder examination?

Answer 5

Inspection of surroundings:

• Aids e.g. slings
• Prescriptions

General inspection of pt:

• Body habitus
• Scars
• Wasting of muscles

Closer inspection of shoulder- look at anterior, lateral and posterior:

• Scars
• Bruising
• Swelling
• Deformity
• Muscle wasting
• Sinuses
• Scolioisis
• Winged scapula

Question 6

What should you do in the palpate stage of your shoulder examination?

Answer 6

• Check temperature (compare both sides using dorsum of hand)
• Feel for tenderness working medially to laterally:
  
  • SCJ
  • Clavicle
  • ACJ
  • Coracoid process
  • Acromion
  • Scapula spine
  • Medial border of scapula
  • Greater tuberosity of humerus
• Feel for any swelling

Question 7

The move part of the shoulder can be split into numerous sections; state these

Answer 7

• Active movement
  
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • External rotation
  • Internal rotation
• Passive movement
  
  • Flexion
  • Extension
  • Abduction
  • Adduction
  • External rotation
  • Internal rotation

Question 8

Explain how you will ask the pt to show active:

• Flexion
• Extension
• Abduction
• Adduction
• External rotation
• Internal rotation

Answer 8

• Ask pt to keep arm straight and move arms uptowards ceiling
• Extension: ask pt to stretch arms out behind them
• Abduction: ask pt to raise arms out to side in arc like motion until hands touch above head
• Adduction: keeping elbows flexed and arms by side cross arms over body
• External rotation: arms in front with elbows flexed at 90, move arms out keeping elbows by sides
• Internal rotation: put hand behind back and reach up as far as can (normal T4-T8)

Question 9

Explain how you will elicit the following passive movements:

• Flexion
• Extension
• Abduction
• Adduction
• External rotation
• Internal rotation

Answer 9

SAME as for active but you support weight of pts limb, you move their limb and with other hand feel for crepitus in joint

Question 10

What should you do in the special tests stage of your shoulder examination?

Answer 10

Need to examine integrity of all 4 rotator cuff muscles

• Supraspintous: empty can test
• Infraspinatous & teres minor: posterior cuff test/external rotation against resistance
• Subscapularis: Gerber’s lift off test

Also do????:

• Check winging of scapula
• Painful arc
• Neer’s test
• Hawkin’ Kennedy test
• Scarf test

Question 11

What should you do in the neurovascular assessment?

Answer 11

??

Axillary nerve examination?

Neurological examination?

Neck?

Question 12

What should you do in the completing your examination stage of the shoulder exam?

Answer 12

• Thank pt
• Further investigations/tests:
  
  • Examine C-spine and elbow
  • Assess neurovascular status of both upper limbs
  • Review any imaging of the joint or obtain x-ray of joint

Question 13