Shoulder Exam

Question 1

Shoulder exam - Look

Answer 1

Anterior:

• Contour of the shoulder
• Deltoid and trapezium muscle bulk
• Sterno-clavicular and acromioclavicular joint deformity
• Clavicle for deformity
• Scars

Laterally:

• Shoulder contour
• Sterno-clavicular and acromio-clavicular joints

Posteriorly:

• Supraspinatus and infraspinatus fossae for muscle wasting
• Scapula for evidence of asymmetry

Axilla:

• Swellings
• Scars

Question 2

Shoulder exam - Feel

Answer 2

• Sterno-clavicular joint
• Clavicle
• Acromio-clavicular joint
• Acromion
• Long head of biceps
• Scapula - spine and body

Question 3

Shoulder exam - Move

Answer 3

• External rotation (thumbs up, upper arm at sides)
• Forward flexion
• Abduction
• Internal rotation (record as the vertebral level reached by the hand on the back)

Question 4

Shoulder exam - Suspected acromioclavicular joint (ACJ) pathology

Answer 4

Scarf test

• Abduct and flex the shoulder directly across the neck as if the arm is a scarf
• Positive test = pain felt at the site of the ACJ

Question 5

Shoulder exam - Suspected rotator cuff tear

Answer 5

Supraspinatus Jobe’s test

• With shoulder abducted and slightly flexed forward, instruct the patient rotate hand the hand to point their thumb towards the floor
• Ask the patient to try to maintain this position while you push down on their forearms
• Positive test = muscle weakness evident. If there is only pain but no weakness, supraspinatus impingement is likely

Infraspinatus (and teres minor)

• Test power of external rotation against the resistance of your hand pushing against the patient’s forearm
• Positive test = muscle weakness evident

Subscapularis

• Test power of internal rotation by asking the patient to put their hands behind their back with the dorsum of their hand against their buttock and to push their hand against yours
• Positive test = muscle weakness evident

Question 6

Shoulder exam - Suspected rotator cuff impingement

Answer 6

Test for a painful arc

• Instruct the patient to raise their arms out to side and above their head (active abduction)
• Positive test = pain is experienced between 80-150 degrees of abduction

Hawkins-Kennedy test

• With the shoulder flexed forward and the elbow bent, internally rotate the arm
• Positive test = pain is exacerbated

Jobe’s test

• See above for suspected rotator cuff tear
• Positive test = pain is exacerbated

Question 7

Shoulder exam - Suspected shoulder instability

Answer 7

Test for the sulcus sign

• With the patient standing, arm straight and relaxed by their side, place one arm on the shoulder girdle (on top of the shoulder) to stabilise
  it
• Use your other hand to hold the wrist and exert a force in an inferior direction
• Positive test = a sulcus sign is seen if a depression appears just below the acromion

Anterior and posterior drawer tests

• With the patient lying supine on the bed, use one hand to stabilise the shoulder girdle, with the other hand, grasp the humeral head and try to displace the shoulder anteriorly and then posteriorly
• Positive test = displacement of the humeral head anteriorly or posteriorly confirms
  instability

Anterior apprehension and relocation test

• With the patient lying supine on the bed externally rotate the shoulder with the elbow flexed
• Positive test = the patient appears apprehensive in this position as the humeral head
  subluxes anteriorly
• The humeral head can be relocated with pressure applied anteriorly to the humeral head, thus resolving the apprehension

Posterior apprehension test

• Push shoulder joint posteriorly from elbow in 90º flexed position
• Do not need to perform, should just be aware