The document summarizes the steps for examining the shoulder, including: Inspection of the anterior, posterior, and lateral sides. Palpation of structures like the acromioclavicular joint, coracoid process, and long head of the biceps tendon. Assessment of muscle strength for scapular stabilizers. Evaluation of shoulder movements and special tests for conditions like instability, impingement, rotator cuff tears, and more. The examination provides a thorough overview of evaluating the structures and function of the shoulder.

1. SHOULDER EXAMINATION
PRESENTER – DR.SHARAN HONGAL

2. EVALUATION
Inspection
Palpation
Muscle strength
Movement
Special tests

3. INSPECTION
• Anterior side
• Posterior side
• Lateral
• Overhead
• Axillary

4. ANTERIORLY
• Sternoclavicular joint
• Acromioclavicular joint
• Deltoid
Atrophy
Pain at insertion site mostly referred
from rotator cuff pathology; rarely due
to deltoid tendinitis
• Subacromial region
Swelling- bursitis
Axillary folds

5. Posterior side
• Scapula Position – Sprengel’s
• Spine
• Axillary folds

6. Borders of scapula
Lateral- prominent in LD
atrophy
Superior- prominent in
supraspinatus & trapezius
atrophy
Vertebral- prominent in
serratus anterior
weakness/winging

7. PALPATION
• Anteriorly
Acromioclavicular joint
Sternoclavicular joint
Clavicle
Coracoid process
Subacromial bursa
Long head Biceps tendon
• Posterior
• Medial

8. Acromioclavicular joint
• Examiner pushes
upward on the arm
while pushing
downward the
clavicle with the
other hand

9. • Sternoclavicular joint
Palpate Sternal notch
approx. 1.5 – 2.0 cm lateral
• Coracoid
2 cm inferior to junction of
lateral 1/3 and middle 1/3

10. • Subacromial bursa
Tenderness just anterior to
acromion subacromial bursitis
• Long head Biceps tendon
Shoulder in 10° internal
rotation
Palpate along the line running
from 1 cm to 4 cm distal to the
anterior acromion

11. • Laterally
Deltoid
the examiner places one hand against the
lateral aspect of the patient's distal arm at
the elbow and asks the patient to
isometrically abduct against this resistance.
The index and long fingers of the
examiner's other hand are placed with light
to moderate pressure on the patient's
deltoid approximately 1 cm lateral to the
lateral border of the acromion

12. • Posterior
Trapezius
Rhomboids
scapula
• Medial
Axillary sheath

13. MUSCLE STRENGTH
• SCAPULAR STABILIZERS
Serratus Anterior
originates from the anterior parts
of ribs and inserts on the medial
border of the scapula
Give push ups
Long thorasic nerve

14. Rhomboids
Spinous process of the
C7 to T5 vertebrae to
medial border of
scapula
Attention position
dorsal scapular nerve

15. Trapezius
Spinous process of
vertebrae c7 to t12 to
lateral 1/3 of clavicle
,acromion proess and
spine of scapula
Shrug the shoulder
Spinal accessory nerve

16. MOVEMENTS
FLEXION
EXTENSION
ADDUCTION ABDUCTION

17. NEUROMUSCULAR EXAMINATION
• Motor examination
• Sensory examination
• Deep tendon reflexes

18. • Axillary nerve injury
Autonomous zone-where
single nerve is supplied to non
overlapping skin
Anaesthesia in the
‘Regimental badge area’ due
to injury to axillary nerve

19. SPECIAL TEST
1. INSTABILITY
2. IMPINGEMENT SYNDROME
3. ROTATOR CUFF TEAR
4. BICEPS TENDON PROBLEMS
5. AC JOINT PROBLEMS
6. STIFF SHOULDER

20. • Appley’s scratch test
Patient attempts to touch
the opposite scapula thus
testing abduction &
External Rotation and
adduction & Internal
Rotation
Good screening test for
ROM assessment

21. ANTERIOR DISLOCATION
• Hamilton Ruler test – straight ruler cannot touch acromion process
and lateral epicondyle
• Duga’s test
• Callaway’s test

22. POSTERIOR DISLOCATION
• EXTERNAL ROTATION restricted
• Prominence in posterior deltoid

23. INSTABILITY
• Unidirectional- anterior, posterior, inferior
• Multidirectional (MDI) – anterior &/ or posterior with inferior

24. ANTERIOR
Apprehension test
• Crank test – Patient sitting; arm at
90° Abduction. With increasing
External rotation the examiner
exerts an anterior translatory force
with his thumb placed posteriorly
on the humerus & watches for
apprehension.
subluxation or dislocation

25. • Fulcrum test –Patient lying
supine with the scapula
supported by the edge of the
table. The arm is positioned in
90° Abduction. With increasing
External rotation the examiner
watches for apprehension.

26. POSTERIOR
• Jerk test- Patient in 90° forward
flexion of shoulder & elbow
flexed to 90°, examiner applies
posterior directed force by
holding the forearm.
• Jerk/Jump = dislocates out of the
glenoid posteriorly

27. INFERIOR
• Sulcus sign
Downward traction applied
Dimpling of the skin below the
acromion or widening of the
subacromial space on palpation
purpose of this traction is to sublux
the humeral head inferiorly in
relationship to the glenoid fossa

28. IMPINGEMENT
• Painful arc syndrome
In abduction arc of motion,
patient feels pain in the
range 60-120°.

29. • O’Brien test
The patient flexes the arm to 90°
with the elbow fully extended and
then adducts the arm 10-15°
midline. The arm is then maximally
internally rotated and the patient
resists the examiner's downward
force.
SLAP lesions

30. • Hawkins-Kennedy Test
patient sitting with arm at 90° forward
elevation and elbow flexed to 90°.
Examiner then quickly moves the arm
into internal rotation. +ve = Pain located
to the sub-acromial space

31. • Neer Impingement Sign
Examiner performs maximal passive
forward flexion with internal rotation
while stabilizing the scapula.
Pain =maneuver is thought to bring the
pathologic anterolateral acromion into
contact with the affected portion of the
rotator cuff and greater tuberosity,
thereby producing pain

32. ROTATOR CUFF TEAR
• supraspinatus – Empty can test
• infraspinatus - ER at arm at side with elbow flexed
• for subscapularis - Abdominal compression test
• Drop Arm sign
• External rotation lag sign

33. Supraspinatus
“Empty Can Test”
• Patient attempts to elevate the
arms against resistance with arms
at 90° abduction in a plane 30°
anterior true coronal plane and full
Internal Rotation (thumb pointing
downward) with elbows extended.
Positive = impingement of the
suprascapular nerve at the superior
scapular notch

34. • Infraspinatus & Teres minor
Patient’s arms at the sides
with elbows flexed to 90,
attempts to do Externally
rotation
injury to the suprascapular
nerve at the spinoglenoid
notch

35. Subscapularis
• Abdominal compression test
Patient attempts to press the
hand down against abdomen
with examiner preventing it.
Useful when Internal rotation
restricted

36. • Drop Arm sign
Examiner abducts patient’s
shoulder to maximum. After
warning the examiner releases
patient’s arm & asks him to lower
the arm back to the side. Pt able
to lower the arm part way & then
suddenly loses control- arm drops
suddenly to the side. Indicates
large rotator cuff tear Also seen in
axillary nerve palsy

37. • External rotation lag sign
Patient’s arm is externally rotated
maximally and released- arm rotates
internally spontaneously . Seen
when subscapularis is intact but
infraspinatus & teres minor is torn.

38. BICEPS TENDINITIS
Yergasson’s test
• The patient's elbow is flexed
and forearm pronated.
The examiner holds at the
wrist. Patient actively
supinates against resistance.
Pain located to bicipital groove
reflect biceps tendinitis or
instability

39. AC JOINT PROBLEMS
• Cross chest adduction
test
Patient elevates the
affected arm to 90°, then
actively adducts it.

40. STIFF SHOULDER
• Restriction of all range of motion,
MAINLY Abduction & EXTERNAL
ROTATION
External Rotation restriction occurs
in 2 conditions only
1. Stiff shoulder
2. Posterior dislocation

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