Shoulder Examination

May 6, 2009 by   Print
Filed under Resources

Shoulder - 200Format:

  1. Initial impression
  2. Inspection
  3. Range of movement
  4. Muscle strength tests
  5. Stability assessment
  6. Special tests
  7. Palpation
  8. Neurological assessment
  9. Sports specific function

1.  Initial impression:

  • general body condition
  • systemic disease
  • antalgic posture
  • willingness to move
  • level of distress

2.  Inspection:

  • asymmetry
  • swelling
  • scapular position
  • glenohumeral position
  • orientation of dependent arm
  • muscle wasting
  • deformities

3.  Range of Movement

  • examine in upright and supine with overpressure EOR as applicable.
  • Look for quality & potential compensations
  • Total elevation
  • Abduction + / – differentiation
  • External rotation
    • dependant
    • 90 º abduction
  • Internal rotation (hand behind back)
  • Horizontal flexion

4.  Muscle strength testing: (stand & supine)

  • specific muscle weakness / neurological deficit ?
  • strength through range.

Scapular control on thorax:

  • Trapezius
  • Serratus Anterior

Humeral control in glenoid:

  • External rotation
  • Internal rotation

5.  Stability assessment: may be unidirectional or multidirectional

  • GH translation (drawer) test
    • uni or multidirectional
    • instability
  • Sulcus test – inferior instability
  • Apprehension (crank) test – anterior instability
  • Relocation test – anterior instability.
  • Jerk test – posterior instability
  • Push – pull test – posterior instability

6.  Special tests:

  • Impingements
    • multifactorial etiology, structures potentially involved – rotator cuff,
    • Long head of Biceps, sub-acromial bursa, plexus.
  • Tests (specificity imprecise):
    • flexion (EOR)
    • Flexion / internal rotation
    • Speed’s test (LHB impingement)
    • Ludlington’s test (LHB impingement)
    • Abduction
    • Dynamic impingement test (Allingham’s test)
    • Impingement test with local steroid
  • Neurodynamic test (ULTT1)
  • Cervical screening:
    • physiological with overpressure
    • Combined movements

7.  Palpation:

  • Rotator cuff, LHB, A/C joint, muscle tone.
  • Accessory joint movement – 3 key movements
  • Quadrant & locking positions

8.  Neurological:

  • Reflexes.
    • C5 – Deltoid
    • C5&6 – Biceps
    • C6 – Brachioradalis
    • C7 – Triceps
    • C8 – Pronator Quadratus
  • Power.
    • C1&2 – Occipital flexion /extension
    • C2&3 – Cervical flexion / extension
    • C3&4 -  Shoulder girdle elevation
    • C5      -  Shoulder abduction
    • C5&6 -  Elbow flexion
    • C6      -  Wrist extension / rad. Dev.
    • C7      -  Elbow extension
    • C8      -  Thumb distal phalanx extension
    • T1       -  Fifth finger abduction

9.  Sports specific function:

  • Serving action
  • Swimming action
  • Throwing
  • Lifting

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