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Shoulder Joint Examinitaion
Shoulder Joint Examinitaion
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Shoulder examination

  1. 1. Shoulder Examination Prepared by: Sunil Baniya Student, NAIHS-COM sanobharayang, ktm 1Shoulder examination/ Sunil Baniya
  2. 2. Chief complaints:  Pain  Swelling  Deformity  Stiffness  Instability  Weakness  Loss of function 2Shoulder examination/ Sunil Baniya
  3. 3.  Examination is done either in sitting or standing position with sufficient exposure. 1. Look : Front  Head, neck alignment  Shoulder symmetry  Prominent AC joint/ swelling  Fullness of supra-clavicular area  Wasting of deltoid 3Shoulder examination/ Sunil Baniya
  4. 4.  Axillary area  Any sinus, scars, swelling  Arm position  Small muscles of hand Side  Wasting of supraspinatus & infraspinatus  Winging of scapula  Swelling, sinus, scars Shoulder examination/ Sunil Baniya 4 Fig : winged scapula
  5. 5. Back  Wasting of deltoid  Drooping of shoulder 2. Feel : a. Temperature: - Periphery to centre or proximal to distal b. Tenderness:  For tenderness palpate over - Sterno-clavicular joint - Along clavicle 5Shoulder examination/ Sunil Baniya
  6. 6. - Acromio-clavicular joint - Spine of scapula - Borders - Shoulder joint line - Coracoid process - Biceps tendon in bicipital groove (arm flexion, elbow flexion at 90°, then internally/ externally rotate & palpate) - In axilla palpate humeral head - Fullness of inferior recess in shoulder effusion 6Shoulder examination/ Sunil Baniya
  7. 7. 3. Movement:  Active movement (passive movement need not to be done) - Flexion : 0- 160/ 180° - Extension : 0- 180° - Adduction : 0-15° (cross arm) - Abduction : 0-180° *First 15° = supraspinatus *15-90° = deltoid *>90° = serratous anterior 7Shoulder examination/ Sunil Baniya
  8. 8. - Internal rotation : 15° (touches inferior border of opposite scapula or thumb touches upto T5 spine) - External rotation : 60° (Rotational movement at various position) 4. Special Tests: a. Impingement tests: i) Painful arc test ii) Neer’s impingement test iii) Hawkin’s / Hawkin Kennedy test iv) Jobe’s test/ Empty can test 8Shoulder examination/ Sunil Baniya
  9. 9. b. For Rotator cuff tendon tear: i) Drop arm test ii) Lift off test/ Gerber’s test c. For Rotator cuff instability: i) Apprehension test ii) Jobe’s relocation test iii) Sulcus test 9Shoulder examination/ Sunil Baniya
  10. 10. Painful arc test:  for painful arc syndrome  shoulder pain occurring at 60-120° of arc  Described when arm is abducted from the side to fully raised position  +ve in supraspinatus tendinitis 10Shoulder examination/ Sunil Baniya During active abduction, the scapulohumeral rhythm is disturbed on the right and the patient starts to experience pain at about 60 degrees (a). As the arm passes beyond 120 degrees (b) the pain eases and the patient is able to abduct and elevate up to the full 180 degrees
  11. 11. Neer’s Impingement test:  Patient standing or sitting  Hand prone  Extending at elbow, passively elevate the arm >90° or above the shoulder  Other hand of examiner fixes the shoulder  +ve pain at anterolateral aspect of shoulder = infraspinatous tendon impingement Shoulder examination/ Sunil Baniya 11 Fig : Neer's impingement sign
  12. 12. Hawkin’s test/ Hawkin Kennedy test:  Fixing scapula/ shoulder  Abduction of shoulder at 90°, forward flexion of elbow  Internal rotation by examiner by grasping just below elbow  Finding : pain at shoulder => Subacromial impingement 12Shoulder examination/ Sunil Baniya Fig : Hawkin's test
  13. 13. Jobe’s test/ Empty Can test:  Patient standing  Arm forwardly flexed at the level of shoulder  Fully pronate arm into empty can position  Ask patient to resist downward force applied  Finding : pain or weakness => Supraspinatus tendon lesion Shoulder examination/ Sunil Baniya 13
  14. 14. Drop arm test:  Passively forward flex the arm after shoulder stabilization by other hand  Bring 90° abduction state  Let the patient to hold his hand in that position  Arm drops  Finding: complete rotator cuff tear 14Shoulder examination/ Sunil Baniya Fig : Drop arm test
  15. 15. Lift off test/ Gerber’s test:  Patient is asked to stand  Place his/her one arm behind his/her back with the dorsum of the hand resting against the mid-lumbar spine  The examiner then lifts the patient’s hand off the back  And the patient is told to hold it there  Finding: Inability to do so=>weakness => rupture of Sub-scapularis tendon (Drawback: needs full internal rotation, can not be done when restricted or pain on doing so) Shoulder examination/ Sunil Baniya 15 Fig : Gerber's lift-off test
  16. 16. Apprehension test:  Sitting upright position  Abduct at 90°, forwardly flex, externally rotate, then try to push shoulder forward extending at the elbow  Pain  See patient’s face for apprehension 16Shoulder examination/ Sunil Baniya Fig : Apprehension test for anterior subluxation or dislocation. Abduct, externally rotate and extend the patient’s shoulder while pushing on the head of the humerus. If the patient feels that the joint is about to dislocate, she will forcibly resist the manoeuvre.
  17. 17. Jobe’s Relocation test:  Patient supine  Arm ½ part at the edge of couch  Externally rotate the forearm  Pain & apprehension appear first  Then press down on arm => should relieve pain or apprehension  Finding: Again pain occurs after release of downward pressure => anterior instability 17Shoulder examination/ Sunil Baniya Fig : Jobe's relocation test
  18. 18. Sulcus test:  For inferior capsular laxity or instability  Patient sitting arm by side  Relaxed arm  Elbow flexed at 90°  Give downward axial force along the humerus by holding elbow  Another hand provide grip between acromian, anterior & posterior 18Shoulder examination/ Sunil Baniya Fig : Sulcus sign
  19. 19. OR,  Arm forward flexion at 90°  Elbow bent at 90° & internally rotated  Finding: sulcus appear between acromial arch and humeral head => test the degree of inferior capsular laxity Shoulder examination/ Sunil Baniya 19
  20. 20. 5. Measurement:  Take only either of two bony points as reference for girth/bulk of humerus i.e; acromian or lateral epicondyle of humerus 6. Axillary lymph nodes 7. Cervical spines 8. Distal Neurovascular Status (DNVS)  Radial pulse  Sensory examination (autonomous zone of radial, median & ulnar nerve)  Motor examination (5 groups = C5, C6, C7, C8, T1) 20Shoulder examination/ Sunil Baniya
  21. 21.  C5 = elbow flexion  C6 = wrist extension  C7= wrist flexion, finger extension  C8 = finger flexion  T1 = finger abduction 21Shoulder examination/ Sunil Baniya
  22. 22. Thank You 22Shoulder examination/ Sunil Baniya

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