Shoulder Exam

Question 1

Order of shoulder exam

Answer 1

Introduce self and confirm identity
Inspection
Palpation
Active ROM
Passive ROM
Muscle tests
Special Tests

Question 2

Inspection shoulder

Answer 2

Inspect anterior and posterior shoulder with patient standing looking for asymmetry, bony deformities, redness, swelling, muscle atrophy, nodules

Question 3

Palpate shoulder

Answer 3

Begin at SC joint, along clavicle to AC joint
Subacromial bursa
Scapula
Deltoid
Long head of biceps tendon
Looking for tenderness, bogginess, bone enlargement

Question 4

Active ROM shoulder

Answer 4

Flexion and Extension
Abduction and Adduction
Internal and External Rotation
External rotation with abduction (hands behind neck)
Internal rotation with adduction (hands behind back)

Question 5

Passive ROM shoulder

Answer 5

Flexion and Extension
Abduction and adduction
Internal and External Rotation
External rotation with abduction
Internal rotation with adduction

Question 6

Muscle tests shoulder

Answer 6

Deltoid- abduct shoulder at 90 against resistance
Supraspinatus- empty can test
Infraspinatus and teres minor- external rotation against resistance
Subscapularis- lift-off test
Serratus anterior- flex shoulder at 90 palpate for scapular winging, may perform wall push up
Rhomboid- arm on hip, push arm forward at elbow with patient resisting. Watch for scapular winging

Question 7

Special tests shoulder

Answer 7

Neer impingement- passive forward flexion of shoulder up to ear, designates impingement syndrome if pain
Hawkins impingement- shoulder flexed at 90 degrees elbow flexed at 90 degrees, passive internal rotation, designates impingement syndrome if pain
Crossover- cross extended arm across chest, designates AC joint arthritis if pain
Apprehension sign- lay supine, abduct, and externally rotate, apprehension occurs due to anterior instability
sulcus sign- apply inferior traction with arm relaxed at side, subluxation indicates inferior instability
jerk- shoulder at 90 degrees flexion, elbox flexed at 90, internal rotation, adduct across body while pushing back on humerus, sensation of posterior subluxation = posterior instability

Question 8

perform the shoulder exam!

Answer 8

did you do it?