Clinical examination and manual therapy of the shoulder and shoulder girdle diagnose precisely. Clinical examination and manual therapy of the shoulder. Feel for example, feeling a joint to see if it is hot or swollen. The purpose of the examination of the hand, wrist and forearm. Passive range of motion motion aaos ama boone jbjs 79 end feel flexion 180 150 166. Position always position your patient as you would like to examine them before you begin. Tendinitis supraspinatus supraspinatus tendinitis is a common inflammatory condition of the shoulder that causes anterior shoulder pain. A stepbystep guide to performing shoulder examination in an osce setting, with an included video demonstration. How i do a 5 minute comprehensive examination of the shoulder.
Activity left arm right arm florida orthopaedic institute. Repetitive stresses placed on the shoulders of overhead athletes may affect range of motion, strength, scapular position, and ultimately, the integrity of soft tissue. Competency based clinical shoulder examination training. Table 2 2 below shows the average range of motion in the dominant and nondominant arm in the healthy population. Physical examination of the shoulder sciencedirect. Request pdf clinical examination of the shoulder this chapter presents a structured shoulder clinical examination, with emphasis on some of the special tests described for shoulder assessment. The diagnosisdriven physical exam of the shoulder april 24, 2014 carlin senter md, natalie voskanian md, veronica jow md. Table 4 provides details of the muscles of the shoulder and figure 38ad illustrations of the anterior and posterior bones and muscles of the upper limb. There are 6 main concepts that need to be remembered for all of the regional examination of the musculoskeletal system. Deformity of the joint and fractures and dislocations are usually obvious figure 37a,b. Part i introduces the concepts of subjective evaluation, observationposture, related referral joint testing, neurovascular testing, palpation, and range of motion testing.
It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuffspecific testing biceps testing. In this series, a normal test result was seen in 100 patients who had no shoulder complaints, 27 patients with a fullthickness rotator cuff tear not involving the sub. Mastery of the shoulder examination is recommended in the association of american medical colleges musculoskeletal content report. The format consists of initial impression, inspection, palpation, range of. Swelling of the shoulder joint may be visible due to a joint effusion, or synovial thickening. Briefly explain to the patient what the examination involves. Passive abduction in internal rotation in the scapula plane painful. History taking and clinical examination of the shoulder. Shoulder scopy for whom emphasis on clinical examination. Instability the common disorders arise from diseases of the following structures. Shoulder instabilities sulcus sign passively pull down on arm, look for sulcus, but commonly found in normal patients multidirectional shoulder instabilities yergasons test flex elbow past 90, arm at side, pronate forearm, resist pt. The first is to identify orthopedic shoulder physical examination special tests with the best clinical utility statistics to ease the diagnostic process through usage of an examination algorithm. Reliability of physical examination tests used in the assessment of.
Discussion a description of the different tests is given, with photographs of the exact test procedure. At the conclusion of this program, the learner will be able to. The patients history allows the physician to direct the physical examination because not every physical examination test is necessary for every patient. Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. Adults below 40 years present due to impingement, frozen shoulder or acj arthritis. Clinical examination of the shoulder girdle is an accessory to. Examination of the shoulder joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient to expose their shoulders fully inspection look anterior, lateral, and posterior asymmetry or deformity scars or skin changes muscle bulk palpate temperature. Physical examination of the shoulder is an important adjunct to the patients history, which helps focus the decisionmaking process and guides appropriate treatment. Shoulder movements are composite, involving the ball and socket articulation at the shoulder glenohumeral joint, together with movements between the scapula and clavicle, and the thorax. References shoulder girish g, lobo lg, jacobson ja et al. Utilize an exact knowledge of shoulder pathoanatomy, physiology, and biomechanics. Part ii comprises the bulk of the text, covering the major shoulder. Modified athletic shoulder form reinold, wilk, andrews xiv. Examination of related areas the shoulder joint area is the site for referred pain in certain conditions, which must be borne in mind.
The steps of physical examination of shoulder is determined by patients presenting complaints and history. If you want to learn exactly how to perform my clinical examination of the shoulder, i also have a comprehensive video that shows you my entire examination with detailed videos explaining each of the components and special tests. Finally the shoulder may become uncomfortable even with the arm at rest and by then the acute symptoms are brought about with less forceful activities such as turning the steering wheel of a car or when the patient puts the arm in the sleeve of a coat. Exam and imaging of the shoulder american college of. Shoulder examination introduction shoulder disorders are can be broadly classified into the following types. Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of. Examination of the hand, wrist and forearm february 19, 2004 the purpose of the shoulder and elbow is to position the hand physical examination is derived from anatomic knowledge superficial anatomy anatomic snuff box extensor pollicis. The examination of all joints follows the general pattern of look, feel, move as well as occasionally special tests, in which this station has many. Practical, clinically focused, and highly illustrated, this new guide includes content not covered in any other book, presented in a userfriendly format. How i do a 5 minute comprehensive examination of the shoulder c. Currently, almost without exception, there is a lack of clarity with regard to whether common tests used in clinical examination are useful in differentially diagnosing pathologies of the shoulder hegeduset al. The etiology is most of the time traumatic and related either to sport or accidents. The range of these movements is dependent on a number of factors including age, sex, pathology and on which side is dominant 3, 4. Physical examination and common pathological conditions of the shoulder mr p sarda consultant orthopaedic surgeon cmft epidemiology 2nd only to knee pain for specialist referrals most common causes in adults peak age 4060 subacromial impingement syndrome rotator cuff related 2040 years instability calcific.
Reviewed in the united states on september 21, 2008. The complex structure of the shoulder, with its variable pathological conditions of rotator cuff disease, degenerative joint disease, and type ii slap lesions, makes clinical examination and assessment difficult for both new and experienced practitioners. Bobby masocol md primary care sports medicine fellow. You should ensure you are able to perform this confidently. Aaos clinical guideline on shoulder pain, in orthopaedic knowledge update. The basic functional examination may show some abnormal.
Shoulder exam stanford medicine 25 stanford medicine. The functional examination of the shoulder girdle is never done as primary testing but follows evaluation of one of the other. Agerelated prevalence of rotator cuff tears in asymptomatic shoulders. The standard process of look, move, feel should be used 17. Shoulder symptoms due to an irritated diaphragm being supplied by the same nerve root innervations c4, c5 may be seen in a myocardial infarction. Place 1 hand behind the back and push out against resistance. Clinical examination of the shoulder complex martin boublik, md richard i. Physical examination of the shoulder will serve as an invaluable resource for practicing orthopedic surgeons, sports medicine specialists, physical therapists, residents in training and medical students interested in the field of clinical orthopedics.
Skillful examination of the shoulder is an integral part of this evaluation and is necessary to generate an appropriate differential diagnosis and to help determine whether advanced imaging is needed. Shoulder pain is one of the most common complaints in the outpatient setting. Pain suggests ac pathology apprehension test o have the patient in the supine position, with the arm abducted 90 degrees and elbow flexed. Prompt and effective diagnosis and treatment for common shoulder problems depends on the ability of practitioners to distinguish between traumatic and nontraumatic shoulder conditions. Clinical examination of shoulder linkedin slideshare. A number of specific tests of instability are outlined including an examination technique for.
A shoulder examination or shoulder exam is a portion of a physical examination used to identify potential pathology involving the shoulder. With dvd containing narrated footage of examination techniques. When imaging studies are indicated during the initial evaluation and treatment of a patient. On examination, the asymptomatic shoulder should be observed and serves as a benchmark for comparison of the affected shoulder. Principle movements of the shoulder are flexion, extension, abduction, adduction, internal and external rotation. Shoulder pain is the third most common musculoskeletal reason for seeking medical care, 6,7 affecting between 7% and 26% of adults at any time. Look inspect and observe the patient and around the patients bedside. Shoulder pain leads many patients to see a primary care physician. These questions are about how you feel and how things have been with you during the past 4 weeks. This article aims to enable practitioners to make accurate assessments and carry out shoulder examinations, including the undertaking of selected special tests. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint.
For each question, please give the answer that comes closest to. The large number of shoulder examination techniques, often named. The evaluation of patients with shoulder dysfunction or pain can be difficult. The physical examination is detailed in order of inspection, palpation, and motion, and then considerable emphasis is given to specific shoulder tests looking for evidence of rotator cuff weakness, impingement, biceps pathology, and instability. The shoulder examination, along with all other joint examinations, is commonly tested on in osces.
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