Detailed examination

1. SHOULDER EXAMINATION

2. Inspection
From the front, side and above
 Scars
 Shoulder Alignment
 Swelling
 Muscle Wasting
From behind
 Scar
 Shoulder Alignment
 Scapula Symmetry
 Muscle Wasting

3. Feel
 Sternoclavicular joint to the acromioclavicular joint
and acromion and coracoid process
 Greater and lesser tuberosity
 Glenohumeral joint
 Bicep tendon
 Spine and border of scapula

4. Move
 Always examine the cervical spine
 Move both arms at the same time. Active then passive
range of movement
 Quick Screening Test:”Arms above the head and
behind the back

5. Range of Motion
 Forward flexion:
 160 – 180°
 Extension:
 40 - 60°
 Abduction:
 180◦
 Adduction:
 45 °
 Internal rotation:
 60 - 90 °
 External rotation:
 80 - 90 °
Apley Scratch Test

6. Special test
 Subacromial impingement
 AC joint
 Rotator cuff integrity
 Biceps
 Deltoid
 Serratus anterior
 Instability testing

7. Impingement Signs
 Neer’s Sign
 Arm fully pronated and
placed in forced flexion
 Trying to impinge
subacromial structures
with humeral head
 Pain is positive test

8. Impingement Signs
 Hawkin’s Sign
 Arm is forward elevated
to 90 degrees, then
forcibly internally
rotated
 Trying to impinge
subacromial structures
with humeral head
 Pain is positive test

9. AC Joint: Cross-Arm Adduction Test
 Arm flexed to 90°
 Arm adducted to > 45°
 Hyperadduct shoulder
(down on elbow)
 Positive test is pain in AC
joint

10. Rotator Cuff Integrity:
Supraspinatus/ Anterosuperior cuff:
Jobe’s test
 Arm anteriorly flexed at the level of the
shoulder
 Fully pronate the arm into the “empty
can position”
 Patient should resist downward force
applied on the forearm by the examiner
 Positive finding -> pain or weakness
indicates a supraspinatus tendon lesion

11. Rotator Cuff Integrity:
Posterior cuff(infraspinatus + teres
minor)
Drop-Arm Test
 Abducted arm slowly lowered
 May be able to lower arm slowly to 90° (deltoid
function)
 Arm will then drop to side if rotator cuff tear
 Positive test
 patient unable to lower arm further with
control
 If able to hold at 90º, pressure on wrist will
cause arm to fall

12. Rotator Cuff Integrity:
Posterior cuff(infraspinatus + teres minor)
Other tests
 Patte’s test
 Hornblower’s sign

13. Rotator Cuff Integrity:
Subscapularis/anteroinferi
or cuff:
Belly-Press test:
Posture: patient is sitting with the hand of the
affected arm on the abdomen.
▶ Test: patient exerts pressure on the abdomen
with the hand until maximal internal
rotation.
▶ Pay attention to: the patient feels weakness
and cannot maintain maximal internal
rotation. The elbow drops backwards, and
internal rotation is lost. Pressure is exerted by
extension of the shoulder and flexion of the
wrist

14. Other test
 Gerber’s test
 Internal rotation lag sign

15. Instability: Sulcus Sign
 Inferior instability
 Arm relaxed in neutral
position
 Arm pulled downward at
wrist
 Positive test is a visible
sulcus at infra-acromial
area
 Compare to
contralateral side

16. Instability: Apprehension Test
 Anterior instability
 Shoulder abducted to 90°
 Slight stress to humeral
head directed in anterior
direction
 While externally rotating
shoulder
 Positive test is
apprehension due to
feeling of instability or
impending dislocation
 Beware if false positives

17. Relocation Test
 Anterior instability
 After a positive
apprehension
 Apply posteriorly directed
force over externally
rotated humeral head
 Positive test is relief of
apprehension

18. Instability: Anterior release test
Release of downward pressure
causes pain.

19. THANKYOU