Should3r

Question 1

What are the principles of any ortho exam?

Answer 1

Look
Feel 
Move
Special tests
(Measure, Neurovascular assessment, associated joints)

Question 2

What do you look for in shoulder examination?

Answer 2

Normal shoulder contour/asymmetry
Skin: erythema, scars, lacerations
Soft tissue: swelling, inflammation, muscle wasting
Bones: clavicular deformity, winging of scapulae

Question 3

What might deformity in the middle of the clavicle suggest?

Answer 3

Previous clavicular fracture

Question 4

What might deformity at the distal end of the clavicle suggest?

Answer 4

Acromio-clavicular joint subluxation

Question 5

What can cause winging of the scapulae?

Answer 5

Damage to long thoracic nerve supplying serratus anterior

Question 6

What do you feel for in shoulder examination?

Answer 6

Deformity
Tenderness
Temperature
Swelling

Question 7

What may tenderness over the acromio-clavicular joint suggest?

Answer 7

Osteoarthritis

Question 8

What may tenderness over the greater tuberosity suggest?

Answer 8

Impingement

Rotator cuff pathology

Question 9

What movement may suggest impingement syndrome?

Answer 9

Painful arc of abduction between 60 - 120 °

Question 10

What is normal flexion?

Answer 10

180°

Question 11

What is normal extension?

Answer 11

50°

Question 12

What is normal external rotation?

Answer 12

60°

Question 13

What condition most affects the movement of external rotation?

Answer 13

Frozen shoulder

Also lost early in glenohumeral joint arthritis

Question 14

How do you assess flexion/extension?

Answer 14

Move straight arms all the way up in front of you then behind

Question 15

How do you assess abduction?

Answer 15

Move straight arms all the way up laterally

Question 16

How do you assess external rotation?

Answer 16

Bend elbows to 90° then move forearms outwards

Question 17

How do you assess internal rotation?

Answer 17

Reach as far up as you can on your back with your thumb

Measure according to corresponding vertebrae

Question 18

What would be considered normal internal rotation?

Answer 18

Reach at least inferior border of scapula

Question 19

How can you assess subscapularis?

Answer 19

Patient’s hand behind back, try to lift off against resistance

Question 20

How can you assess infraspinatus (and teres minor)?

Answer 20

External rotation against resistance

Question 21

How can you assess supraspinatus?

Answer 21

Patient hold at 30° abduction and flexion against resistance

Question 22

Which rotator cuff muscle tear is most common?

Answer 22

Supraspinatus tears

Question 23

What are the special tests for impingement?

Answer 23

Jobe’s test (empty can test)

Hawkins -Kennedy Test

Question 24

How do you carry out Jobe’s test?

Answer 24

Flex to 90, abducted in scapula plane with thumbs up - push up against resistance
Same with thumbs down

Question 25

Why is impingement pain more likely when thumbs down in Jobe's test?

Answer 25

Internal rotation brings greater tuberosity of the humerus under the acromion process, compressing the supraspinatus tendon

Question 26

How do you conduct the Hawkins-Kenney test?

Answer 26

Abduct shoulder and flex elbow 90° | Passively rotate arm downwards and continue while adducting the humerus

Question 27

What test can be performed to indicate acromioclavicular joint arthritis?

Answer 27

Cross arm test / scarf test

Question 28

How do you carry out cross arm test / scarf test?

Answer 28

Flex elbow to 90° and forcibly adduct across the chest

Question 29

What are the tests for instability?

Answer 29

Anterior/posterior draw test Sulcus test Apprehension test

Question 30

How do you perform the anterior/posterior draw test for laxity?

Answer 30

Stabilise shoulder with one hand, grip proximal humerus with the other Then apply anterior and posterior traction force to humerus

Question 31

What does the sulcus test demonstrate?

Answer 31

Inferior instability of glenohumeral joint

Question 32

How do you perform the sulcus test?

Answer 32

Stabilise shoulder with one hand Downward traction force to epicondyles of the humerus Positive test if sulcus visible under acromion process

Question 33

How do you perform the apprehension test?

Answer 33

Patient upright or supine Abduct shoulder and flex elbow to 90° Then externally rotate shoulder whilst watching face Positive test - look of apprehension on patient's face as shoulder feels close to dislocating

Question 34

How do you assess for winging of the scapulae?

Answer 34

Push off test | Get patient to push off the wall using both hands

Question 35

How would you complete the shoulder examination?

Answer 35

Assess joints above and below - cervical spine and elbow Neurovascular assessment of affected limb Thank patient and consider ordering appropriate imaging