This document provides an overview of the physical examination of the shoulder, including: 1. The anatomy of the shoulder including bones, muscles, and ligaments. 2. Descriptions of various motions of the shoulder like flexion, extension, abduction, and rotation. 3. Details on clinical assessment including inspection, palpation, and special tests to evaluate the shoulder for issues like impingement, instability, and thoracic outlet syndrome. Special tests evaluate specific muscles, ligaments, and structures of the shoulder.

1. PHYSICAL EXAMINATION OF
THE SHOULDER

2. Introduction
Combined & coordinate movements of 4 joints :
1. Glenohumeral jt
2. Scapulothoracic articulation
2. Acromioclavicular jt
3. Sternoclavicular jt
5. Pseudo jt humerus-coraco acromial arch

3. Anatomy
• Bone
• Humerus
• Scapula
• Clavicula
• Soft Tissue
• Muscle: deltoid, pectoralis major&
minor, rotator cuff
• Ligaments
• Capsule
• Labrum

4. Glenohumeral Joint
•“Shoulder joint;” synovial,
multiaxial ball and socket
•Great mobility with some
sacrifice of stability
•Passive: Vacuum, adhesion&
cohesion, Scapular inclination,
Ligament, capsule, Glenoid
Labrum, Bone
•Active:Biceps (long head),
Rotator Cuff

5. Surface motion of GH joint Primarily rotation
with combination of
gliding & rolling

6. Acromioclavicular ( AC )
• Small synovial articulation
• Distal clavicle – proximal acromion
of scapula
• Surrounded by dense fibrous capsule (
incl Sup & inf AC ligament )
• Stability by 2 part of coracoclavicular
lig :
- conoid
- trapezoid

7. Sternoclavicular Joint
•Synovial articulation
•Between Manubrium sternum – proximal clavicle
•Principle stabilizer : costoclavicular ligament
controls motion , as fulcrum
CC lig
Attach clav to
1st rib
meniscus

8. Scapulothoracic Joint
•Bone muscle articulation  scapula : thoracic wall
•Scapula moves over rib cage and serratus anterior
and supported by clavicle (AC) & sternum (SC),
trapezius, rhomboids, levator scapulae & serratus
anterior

9. e: elevation
d: depression
m: medial rotation
l: lateral rotation
u: upward or downward

10. Shoulder Muscles & Action

12. Clinical Assesment
•Symptoms
- Pain
- Reffered pain
- Stiffness
- Swelling
-Deformity
-Instability
-Weakness
-Loss of function

14. Look
• from the front, side, above, and behind
• suitably undressed
• Head - C spine - Thorax
- Skin : scars, redness, or ecchymosis (axilla
- Shape : asymmetry, winging, wasting
muscles, swelling, SCJ or ACJ deformity
- Position : internal/ external rotation

15. Look

16. Sulcus sign

17. Dislocation of AC joint
Step deformity

18. Winging of scapula
Dynamic winging (winging with movement) :
• long thoracic n. --> serratus anterior (medial)
• spinal accessory n. --> trapezius palsy (lateral)
Static winging (occuring at rest) :
• structural deformity of scapula, clavicle, ribs, or spine

19. Winging of scapula

20. •Posterior
prominence &
rounding
•Flattening anterior
aspect
•Coracoid process
prominence
Posterior Dislocation

21. Feel
• Sternum – SC – Clavicle – AC – Glenoid – Acromion – Scapulae
• Skin (temperatur)
• Bony points & soft tissues. Biceps tendon / bicipital groove.
sternoclavicular, acromioclavicular, acromion· Greater and lesser
tuberosity, feel for rotator cuff defects
• Glenohumeral joint: anterior and posterior aspects

23. Move
- Active movements - Power
- Passive movements - Other joints

24. ACTIVE & PASSIVE
MOVEMENTS
 Forward flexion - Extension
 Abduction - Adduction
 External & internal rotation

25. Flexion – Extension (Sagital Plane)
•Flexion/ forward elevation (0⁰ - 180 ⁰)
•Extension/ backward elevation (0⁰ – 60°)
Flexion Extension

26. Abduction – Adduction (coronal plane)
Abduction (0⁰-180⁰)  0⁰ -120⁰ GH,
120⁰ -180⁰ ST
Adduction (0⁰- 50⁰)

27. Rotation of Scapula on Thorax in Scapular Plane
Ratio glenohumeral and
Scapulothoracic (2:1 / 120⁰:
60 ⁰)

28. External & internal rotation (Horizontal Plane)
•Performed with arms are closed the body elbow flexed
90°
 External rotation (0 -80 °)Internal rotation (0 -70°)

29. Special Tests
Pain

30. Neer’s impingement Sign
• Purpose: Impingement
supraspinatus/ long head bicep
(subacromial/ RC tear)
• Position: seated or stand
• Technique: scapula is stabilized,
raise shoulder flexion, abduction,
internal rotation
• Interpretation: pain subacromial
space / anterior acromion

31. Neer’s test
• Same with Neer’s sign but after injecting 10 ml/ 1 % lignocain into
subacromial space, the pain is reduced.

32. Hawkins/ Kennedy Test
• Purpose: impingement supraspinatus
(between great tub & coracoacromial)
• Position: Seated or stand
• Technique: shoulder in 90° of flexion,
elbow in 90 ° of flexion, slight
horizontal adduction, & maximal IR
• Interpretation: pain (+) anterolateral
aspect of shoulder

33. Empty Can Test/ Jobe Test
• Purpose: Supraspinatus (tear of
tendon)
• Position: seated or stand
• Technique: arm 90⁰ Abd, 30⁰
Forward Flexion, IR (thumb pointing
to d floor), resist elevation
• Interpretation: pain, weakness

34. Full Can Test
• Purpose: supraspinatus muscle
• Position: seated or stand
• Technique: Elevate UE 30°–45° in
plane of the scapula with ER, resist
elevation
• Interpretation: pain or weakness

35. Resisted External Rotation/ Dropping Sign
• Purpose: infraspinatus muscle
• Position: seated or stand
• Technique: arms close to the body,
the elbows flexed to 90 degrees,
resist ER
• Interpretation: pain or weakness

36. Lag Sign Drop Sign
• Purpose: infraspinatus (tear),
Posterior rotator cuff
• Position: seated or stand
• Technique: elbow flexi 90⁰ arms are
lifted slightly away from the body
and placed in maximum external
rotation
• Interpretation: cannot maintain that
position and the arm to drift into a
more neutral position
• Purpose: infraspinatus
(tear), Posterior rotator
cuff
• Position: seated or stand
• Technique: lifts and places
the arm in 90 degrees of
abduction, the elbow at a
right angle and the arm
maximally externally
rotated;
• Interpretation: arm ‘drops’

37. Lag Sign Drop Sign

38. Hornblower’s Test (Patte Test)
• Purpose: Teres minor muscle
• Position: seated and stand
• Technique: Shoulder in 90° abd &
elbow flexed so that the hand
comes to the mouth (blowing a
horn)
• Interpretation: pain, inability to
maintain position

39. Gerber’s Lift-Off Sign
• Purpose: Subscapularis muscle
• Position: seated or stand
• Technique: place arm behind back
with the dorsum of the hand resting
against the midlumbar spine and
then lifts the hand off the back and
hold it there
• Interpretation: inability to hold this
position.

40. Belly Press or Napoleon Sign
• Purpose: Subscapularis muscle
• Position: seated or stand
• Technique: Press the hand into belly
• Interpretation: pain &/or inability to
IR; substitution may result in
shoulder elevation or wrist flexion

41. Bear- Hug Test
• Purpose: Subscapularis muscle
• Position: seated or stand
• Technique: palm of hand on
opposite shoulder (elbow in front of
body), resist IR by attempting to pull
hand off the shoulder
• Interpretation: inability to hold the
hand against the shoulder or
weakness

42. Speed’s Test
• Purpose: biceps tendinitis (long
head) or labrum
• Position: seated or stand
• Technique: resisted flexion with the
elbow straight and the forearm
supinated
• Interpretation: pain at bicipital
groove

43. Yergason’s test
• Purpose: Transverse Humeral
Ligament or biceps tendinitis (long
head)
• Position: seated and stand
• Technique: Resist elbow flexion with
supination
• Interpretation: pain with
tenosynovitis; clicking or snapping
with torn THL (with resistance from
pronation to supination)

44. O’brien’s Test
• Purpose: Labrum (SLAP lesion)
• Position:seated or stand
• Technique: Flex arm 90⁰, elbow full
extension, adduct arm 10-15⁰,
Resist elevation in IR then repeat in
ER (supination)
• Interpretation: pain in IR > ER; pain
“inside” shoulder is labrum & pain
“on top” of shoulder is AC

45. Special Tests
Instability

46. Apprehension test
• Purpose: anterior instability of GH
• Position: Supine, seated
• Technique: abduct the shoulder to
90⁰, external rotation, and pushing
head of humerus with thumb
• Interpretation: pain, sense that
humeral head is about to slip out
anteriorly (apprhension)

47. Relocation Test
• Purpose: anterior instability of GH
• Position: supine or seated
• Technique: abduct& external
rotation shoulder, when pain (+)/
apprehension (+), pres down on
upper arm
• Interpretation: relieve pain/
apprehension

48. Anterior Drawer test (Gerber and Ganz)
• Purpose: anterior instability of GH
• Position: supine
• Technique:shoulder abduction 90⁰,
slight flexion & external rotation.
Steadying the scapula with thumb
on coracoid and finger behind, move
humeral head anteriorly
• Interpretation: movement, clicks
and apprehension

49. Posterior Drawer Test
• Purpose: posterior instability of
GH
• Position: Supine
• Technique: elbow flexion, shoulder
flexion 20⁰ & abduction 90⁰. Place
thumb lateral to coracoid. Internal
rotation & flexi 80⁰ shoulder. Press
humeral head backward with
thumb.
• Interpretation: backward
displacement of humeral head

50. Jerk Test
• Purpose: Posterior Instability of
GH
• Position: Supine
• Technique: flex shoulder to 90⁰ &
elbow to 90⁰, push downward on
the elbow
• Interpretation: pain, jerk/ jump of
head humerus will be felt

51. Sulcus Sign
• Purpose: inferior instability of GH
• Position: Stand
• Technique: grasp arm and pull it
downward
• Interpretation: Sulcus sign (gap
between humeral head and
acromion)

52. Thoracic Outlet Syndrome (TOS)

53. Adson’s Test
• Purpose: TOS @ Scalene triangle
• Position:Seated or stand
• Technique: palpating radial pulse,
move shoulder into abd, ext & ER,
the patient rotates head toward
involve side and takes deep breath&
hold it
• Interpretation: absent or diminished
radial pulse and symptom
reproduced

54. Wright’s Hyperabduction Test
• Purpose: TOS @ coracoid/rib & under
pectoralis minor
• Position: Seated and stand
• Technique: palpating radial pulse,
abduct shoulder 180⁰ in ER, the patient
take a deep breath & hold it
• Interpretation: absent or diminished
radial pulse and symptoms reproduced

55. Military Brace (Costoclavicular) Test
• Purpose: TOS @ 1st & clavicle
• Position: Seated or stand
• Technique: Palpating radial pulse,
retract shoulder into extension &
abduction with neck in
hyperextension
• Interpretation: absent or diminished
radial pulse or symptoms reproduced

56. Allen’s Test
• Purpose: TOS @ pectoralis minor
• Position: seated or stand
• Technique: Shoulder into abduction
90⁰ & elbow flexion 90⁰, turn head
away (contralateral side), take deep
breath & hold it
• Interpretation: absent or diminished
radial pulse or symptoms
reproduced

57. Roos’s Test
• Purpose: TOS
• Position: Seated or Stand
• Technique: Shoulder abduction 90⁰
& ER, Elbow flexion 90⁰. Open&
Closed hand repeatedly for 3
minutes
• Interpretation: symptom or
sensation of heaviness of shoulder

58. Terimakasih