This document provides an overview of performing an examination of the shoulder, including assessing functional anatomy, subjective factors, and objective tests. It describes the resting and closed pack positions of the glenohumeral, acromioclavicular, and sternoclavicular joints. Subjective factors covered include symptoms, aggravating/relieving factors, and past history. The objective examination involves observation, palpation, range of motion testing, strength testing, and multiple special tests to assess various structures like the labrum, biceps, rotator cuff, nerves. The goal is a thorough subjective and physical assessment of the shoulder.

1. EXAMINATION AND ASSESSMENT OF
SHOULDER
- NITHIN NAIR ( MPT - I )

2. OVERVIEW
FUNCTIONAL
ANATOMY
SUBJECTIVE
EXAMINATION
OBSERVATION PALPATION
EXAMINATION
SPECIAL TESTS
OUTCOME
MEASURES

3. GLENOHUMERAL JOINT
RESTING POSITION 40° to 55° abduction, 30° horizontal adduction
CLOSED PACK POSITION Full abduction, lateral rotation
CAPSULAR PATTERN Lateral rotation, abduction, internal rotation

4. ACROMIOCLAVICULAR JOINT
RESTING POSITION Arm resting by side in normal physiological position
CLOSED PACK POSITION 90° abduction
CAPSULAR PATTERN Pain at extreme of rom, especially horizontal adduction and
full elevation

5. STERNOCLAVICULAR JOINT
RESTING POSITION Arm resting by side in normal physiological position
CLOSED PACK POSITION Full elevation and pronation
CAPSULAR PATTERN Pain at extreme of rom, especially horizontal adduction and full
elevation

6. SCAPULOTHORACIC ARTICULATION
 NOT A TRUE ARTICULATION/JOINT
LANDMARKS OF SCAPULA:
 SUPERIOR ANGLE @ T2
 MEDIAL SPINE @ T3
 INFERIOR ANGLE @ T7

7. SUBJECTIVE EXAMINATION
Patient Profile/ Demographic data:
 AGE: Young/middle age adult: Ca++ (calcium) deposits (20-40yrs)
Middle age adult: RC cuff degeneration (40-60yrs)
Middle age/senior adult: frozen shoulder (adhesive capsulitis)
Shoulder dislocation: ↑ recurrence w/↑age
 GENDER: Females > males; prone to frozen shoulder
 OCCUPATION: Overuse – overhead activities
Acute trauma – fall on outstretched hand
 DOMINANCE: Dominant shoulder lower than Non Dominant shoulder
ROM ≠ Both sides
Dominant shoulder shows greater muscularity

8. SUBJECTIVE EXAMINATION
Area of symptoms
 Referred from G-H Joint & Sub-acromion space
 Referred from A-C (acromioclavicular) Joint
 Referred from S-C (sternoclavicular) Joint
 Referred from Shoulder /Scapular muscles

9. SUBJECTIVE EXAMINATION
Type/Description of Symptoms:
 Deep, boring, toothache-like pain – TOS
 Dull toothache-like pain (> night) – Rotator cuff
 Burning type of pain – acute calcific tendinitis
 Clicking, Popping
 Heaviness, Weakness “Dead-Arm” Syndrome
 Locking
 Apprehension
 Painful Arc

10. SUBJECTIVE EXAMINATION
Behaviour of symptoms
What are the Aggravating Factors??
What are the Relieving Factors??
24hr pattern

11. SUBJECTIVE EXAMINATION
 Aggravating factors:
 Reach up, across, behind
 Carrying
 Lifting
 Throwing
 Sleeping – on shoulder, back
 Cervical movements -aggravating, ease
 Relieving factors
 Rest
 Support
• Position
• Pillow
• Sling

12. PAST HISTORY
 Related to area of complaint
 Related to other areas – sources of referral
 History of CNS, PNS (peripheral nervous system)
involvement

13. SHOULDER O/E: OBSERVATION
 Limb position (either side/held across/support by other hand),
Gait (check arm swing during walking, dressing and general
willingness to use arm)
 Cervical & Thoracic spine curves
 A-C Joint
 Scapulae position, movement (scapulohumeral rhythm)
 Assistive devices (splints/orthosis/ modified)
 Functional Assessment – Hand to opp. Shoulder, Hand behind
back, Hand behind head.

14. PALPATION
Symptom assessment/provocation at regional structures
Note for any muscle spasm, tenderness, abnormal bumps,
temperature or other signs that may indicate source of pathology.
Begin with anterior structures and then working around to the
posterior structures.
Compare injured side to the unaffected side

15. EXAMINATION
AROM (In standing or sitting) – check for willingness for the
movement, quality. Assess Scapulohumeral Rhythm.
PROM - check for quality, symptoms and end feel. ALSO
Comment on joint reactivity and irritability.
Passive accessory movement (joint play) – Glides of GH, AC
and SC Joint. (check for amplitude & pain)
Strength – Resisted Isometric testing (assess – strong/weak;
pain/painless)
Neurological examination: Check for sensations (dermatomes),
reflexes, myotomes

16. SPECIAL TEST
ANTERIOR GH INSTABILITY
• Apprehension Crank test
• Anterior load and shift test

17. SPECIAL TEST
POSTERIOR GH INSTABILITY
• Jerk test
• Posterior load and shift test.

18. SPECIAL TEST
INFERIOR AND MULTIDIRECTIONAL GH STABILITY
• Sulcus sign

19. SPECIAL TEST
ANTERIOR IMPINGEMENT
• Neer Impingement test
• Hawkins-Kennedy test

20. SPECIAL TEST
POSTERIOR IMPINGEMENT
• Posterior internal impingement test

21. SPECIAL TEST
LABRAL LESION
• Active compression test of O’Brien
• Kim test

22. SPECIAL TEST
AC JOINT PATHOLOGY
• AC Crossover, Crossbody, or Horizontal adduction test.
• Paxinos Sign

23. SPECIAL TEST
BICEPS
• Speed’s test
• Yergason’s test

24. SPECIAL TEST
SUPRASPINATUS
• Empty Can (Jobe test)
• Drop arm test

25. SPECIAL TEST
SUBSCAPULARIS
• Lift off sign

26. SPECIAL TEST
INFRASPINATUS
• Infraspinatus test

27. SPECIAL TEST
ROTATOR CUFF (IN GENERAL)
• Rent test
• Whipple test

28. SPECIAL TEST
TRAPEZIUS
• Trapezius test (3 positions)

29. SPECIAL TEST
SERRATUS ANTERIOR
• Punch out test

30. SPECIAL TEST
NEUROLOGICAL FUNCTION
• Upper limb neurodynamic test

31. SPECIAL TEST
THORACIC OUTLET SYNDROME
• Roos test (Elevated arm stress test)
• Adson maneuver