This document provides guidance on performing an orthopedic examination of the shoulder. It outlines the basic steps as look, feel, move, and special tests. For the shoulder examination, it emphasizes tailoring the exam based on suspected problems such as instability in young patients or impingement/rotator cuff tears in older patients. Key parts of examination include inspection for deformities or wasting, palpation of bony landmarks and soft tissues, and assessing the full range of motion including any painful arcs. Special tests are described to detect impingement, specific rotator cuff injuries, or instability. The document stresses performing the exam with knowledge of anatomy and potential diagnoses to both prove and rule out clinical findings.

1. THE ORTHOPAEDIC EXAMINATION

2. BASIC RULES
LOOK
FEEL
MOVE
SPECIAL TESTS

3. SHOULDER EXAMINATION

4. KNOWLEDGE….
 “The eye doesn’t see what the mind doesn’t
know”
 Know common shoulder problems…
 Young – shoulder instability
 Old – shoulder impingement, rotator cuff tear
 TAILOR YOUR EXAMINATION TO WHAT IS
SUSPECTED – P.E IS NOT A SET
ROUTINE

5. LOOK

6.  Adequate exposure! (No shyness in exams!)
 Always look from front, side and back

7. Always search for:
• Deformities
• Swellings
• Wasting
• Scars
• Sinus

9. AXILLA :
ALSO PART
OF
SHOULDER!

10. FEEL

11.  Do it in a sequence
 SC joint → clavicle → AC joint → acromion
→ scapula spine
 Ant and post glenohumeral joint line
 Axilla
 Also feel for warmth

12. MOVE

13. POINTS TO REMEMBER
 Shoulder has 6 axis of movement
 The normal anatomy of glenohumeral joint is
facing anteriorly by 15-20 degrees

14. ABDUCTION / ADDUCTION
 Normal range: 0 – 160/180 degrees
 Supraspinatus → deltoid → scapula muscles
(trapezius / serratus anterior)
 Painful arc
Scapulohumeral rhythm

15. FLEXION / EXTENSION
 Normal range:
 Flexion: 0 – 180
 Extension: 0 – 40
 Always remember the plane of
scapulohumeral joint!

16. EXTERNAL / INTERNAL ROTATION
 Normal both are 0 – 90 degrees
 Best to do with shoulder abducted – Why?
 But beware of dislocatable shoulder!

17. SPECIAL TESTS

18. AIM OF TESTS
1) To detect impingement

19. AIM OF TESTS
2) To detect rotator cuff tear (specific muscles)

20. AIM OF TESTS
3) To detect shoulder instability

21. HOW TO DO
 For impingement – by manually causing
impingement between humerus and
acromion
Neer’s impingement sign Hawkin’s test

22. HOW TO DO
 For rotator cuff tear – motions and power of
each muscle must be tested
Jobe’s test -
Supraspinatus
External rotation test –
Infraspinatus / Teres
minor

23. HOW TO DO
Gerber’s lift off test
Tests for
Subscapularis
Napoleon’s test

24. HOW TO DO
 For instability – to demonstrate the instability
Sulcus sign
Shoulder apprehension test
MUST ENSURE THE SHOULDER IS NOT
DISLOCATED DURING EXAMINATION!!!

25. POINTS TO PONDER
 P.E must be done with knowledge
 It is NOT a set routine
 Must be able to spot diagnosis even before
starting P.E
 Your P.E is to prove the diagnosis by
searching for relevant positives
 And to rule out other diagnosis by searching
for relevant negatives

26. THANK YOU