Shoulder Examination Flashcards Preview

MSK Examinations > Shoulder Examination > Flashcards

Flashcards in Shoulder Examination Deck (67):
1

What are the first things you should do in an examination?

-Introduce yourself
-Confirm patient details
-Wash hands
-Explain procedure and gain consent

2

How should the patient be exposed?

Appropriately, exposing the shoulders.

3

How should the patient be positioned?

Standing

4

What should we ask before starting (after full consent etc)?

If the patient currently has any pain.

5

What is the first step of the actual examination?

LOOKING

6

Where do you inspect the patient from?

Anteriorly, laterally, and posteriorly

7

What should be looked for on the skin?

Scars from surgery or trauma

8

What should we look for in the shoulder girdle anteriorly?

Asymmetry

9

What may asymmetry in the shoulder girdle indicate?

Arthritis
Trauma
Scoliosis

10

What should be looked for around the joints?

Swelling

11

What might swelling indicate? (3)

Inflammatory joint disease
An effusion
Anterior dislocation

12

What should be looked for in the muscles anteriorly?

The bulk - wasting may be observed.

13

What might be the case if the deltoid on one side is wasted?

Axillary nerve injury

14

What should be looked for laterally?

Scars

15

What should be looked for posteriorly in terms of shape?

Asymmetry or deformity

16

What might posterior asymmetry or deformity indicate?

Scoliosis
Nerve injury

17

Which nerve would cause winging of the scapula?

Long thoracic nerve

18

Posteriorly, which muscles should be assessed for their bulk?

Deltoids
Trapezius

19

Which 3 other muscle groups should be assessed posteriorly?

The paravertebral muscles
Supraspinatus fossa muscles
Infraspinatus fossa muscle

20

What should step 2 be, after LOOK?

FEEL

21

What should be felt on palpation?

Temperature across the joint
Joints
Bones
Bony landmarks

22

Which joints should be palpated?

Sterno-clavicular
Acromio-clavicular

23

Which bone should be palpated?

Clavicle

24

Which bony landmarks should be palpated?

Coracoid process
Head of the humerus
Greater tuberosity of the humerus
Spine of the scapula
Borders of the scapula

25

How should this palpation be done?

Comparing each side to the other i.e. similtaneously

26

What is the 3rd step after LOOK and FEEL?

MOVE

27

What are the 2 components of MOVE?

Passive and active movements

28

What movements can be used to screen for shoulder problems?

Ask the patient to put their hands behind their head, and then put their hands as far up their back as possible (like doing the clasp on a bra)

29

What does putting hands behind head test?

Abduction and external rotation

30

What does putting hands as far up back as possible test?

Internal rotation

31

What 5 movements should be tested?

Flexion
Extension
Adduction
Abduction
External rotation

32

How is flexion tested?

Ask the patient to raise their arms upwards above their head

33

What angle range is normal for shoulder flexion?

150-180

34

How is extension tested?

Ask the paient to keep arms straight and stretch out behind them

35

What angle is normal for shoulder extension?

40

36

How is abduction tested?

Ask the patient to raise their arms sideways from their sides as far as possible

37

What angle range is normal for shoulder abduction?

Up to 180

38

How is adduction tested?

Ask the patient to bring their arms straight across their trunk

39

What angle range is normal for shoulder adduction?

30-40

40

How external rotation tested?

Ask the patient to flex their elbows to 90 degrees, then rotate arm outwards in an arc

41

What angle range is normal for shoulder rotation?

80-90

42

How is internal rotation tested?

Putting hands as far up their back as possible

43

Which bone should be individually assessed?

The scapula

44

How should the scapula be felt?

Palpate inferior pole as the patient abducts the shoulder

45

What should the scapula be assessed for?

Degree and smoothness of movement

46

What should be felt at the shoulder when moving it?

If there is any crepitus

47

How should passive movements be done?

Ask pt to relax their arm fully and move their arm for them, all the movements listed above.

48

What special tests can be done?

Jobe's test
The painful arc
External rotation aginst resistance
External rotation in abduction
Internal rotation against resistance

49

What does Jobe's test test?

The function of supraspinatus

50

How is Jobe's test carried out?

Abduct the arm to 90 degrees, then bring forward to about 30 degrees (iine with the scapula). Then internally rotate to point thumb at the floor. Push on arm and patient tries to resist. Do on both arms.

51

What can weakness in Jobe's test indicate?

A tear in supraspinatus

52

What may pain in Jobe's test indicate?

Impingement

53

What does the painful arc test?

impingement of supraspinatus

54

How is the painful arc test performed?

Passively abduct arm to maximum point, then ask patient to lower it slowly themselves

55

Where does impingement of supraspinatus usually cause pain?

Between 60-120 degrees abducion

56

Should the painful arc test be used diagnostically?

No, not on its own, as it is not specific.

57

What does external rotation against resistance test?

Infraspinatus muscle function

58

How should the arm be positioned when testing external rotation against resistance?

Elbow flexed to 90 degrees, arm slightly abducted

59

Why does the arm need to be slightly abducted when testing external rotation against resistance?

To test external rotation against gravity

60

What may pain on external rotation against resistance indicate?

Infraspinatus tendonitis

61

What may loss of power on external rotation against resistance indicate?

Infraspinatus tendon tear or muscle wasting

62

What test assesses the function of teres minor?

External rotation in abduction

63

How is the arm positioned in external rotation with abduction?

The arm adbucted to 90 degrees, and elbow bent to 90 degrees, then passively externally rotate

64

What does internal rotation against resistance test?

Subscapularis muscle function

65

How is internal rotation against resistance tested?

Pt places dorsum of hand on lower back. Apply light resistance and ask the pt to move the hand off their back

66

What does inability to internally rotate against resistance suggest?

Tendonitis or tear of the subscapularis muscle

67

What further tests may be done/suggested?

-Full neuro examination of upper limbs
-Cervical spine and elbow joint examination
-Imaging (X-ray, MRI) if indicated