Introduction
- Wash hands (and don PPE if needed)
- Introduce yourself (name and role)
- Confirm patient’s name and DOB
- Explain what the examination involves
- Gain consent to continue
- Adequately expose the patients upper body
- Ask if patient in any pain before continuing
General Inspection
Clinical Signs
- Body habitus - Obesity increased risk of joint pathology
- Scars
- Muscle wasting
Objects and Equipment
- Aids and adaptations
- Prescriptions
Shoulder Close Inspection
- Inspection in all planes - DWASS - deformity, wasting, asymmetry, scars, swellings
Feel
Temperature
- assess and compare shoulder joint temperature
Palpate - all joints and bones
- Sternoclavicular joint
- Clavicle
- Acromioclavicular joint
- Acromion
- Coracoid process of scapula
- Head of humerus
- Greater tubercle of humerus (slightly anteriolateral to head of it)
- Spine of the scapula
Movement
Active movement
Compound
- Hands behind head - external rotation and abduction
- Hands behind back and reach up - internal rotation and adduction
Isolated
- Flexion
- Extension
- Abduction
- Adduction
- External rotation - and test against resistance (tests infraspinatus and teres minor)
- Internal rotation behind back - and test against resistance (sub scapularis )
- Scapula (abduct shoulder while palpating inferior pole of scapula)
Passive movement
Repeat all the above movements passively feeling for crepitus
- Decreased range of active and passive movement involves one of the ligaments or tendons
- Decreased active but normal passive indicates a nerve or muscle lesion
Special tests
Empty can test
This tests for weakness and/or impingement of the supraspinatus
- Abduct the patients arm to 90 and angle the arm forwards by around 30 so the shoulder is in the plane of the scapula
- Interally rotate the arm so the thumb points down
- Push on the patients arm whilst the patient resists
Painful arc
Also tests for impingement of supra spinatus
- Passively abduct the patients arm to its max
- Ask the patient to slowly lower arm back to neutral
- Pain between 60-120 may indicate supraspinatus pathology
Scarf test
Assesses function of acromioclavicular joint
- Ask to put hand on opposite shoulder
- Apply resistance to the elbow in the direction of contralateral shoulder
To Complete the Exam
- Explain to the patient that the examination is now finished.
- Thank the patient for their time.
- Dispose of PPE appropriately and wash your hands.
- Summarise your findings.
Further Assessments and Investigations
- Neurovascular exams of upper limbs
- Further imaging