Shoulder Examination

Format:

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