Shoulder Physical Examination

  • WIPE, blah blah 🙂
  • Position: standing
  • Proper exposure: from the waist up “ideally”
  • Take vital signs
  • General inspection of the pt and surroundings (walking aids)

 

LOOK:

  • Swelling, Skin changes, Scars
  • Muscle wasting
  • Deformitiesasymmetryalignment
  • Winging of the scapula (ask pt to press against the wall)

 

FEEL: (first ask pt if they have any pain)

  • Temperature
  • Bony landmarks: sternoclavicular joint, clavicle, acromio-clavicular joint, coracoid process, humerual head, GT, spine and borders of scapula
  • Muscle bulk: SCM, pectoralis major, trapezius, deltoid, biceps, triceps
  • Axillary LN!

 

MOVE: (first ask pt if they have any pain)

  • Active + passive + against resistance: (comment on pain, ROM, crepitus, power)
  • Flexionextension
  • Abductionadduction
  • Externalinternal rotation

 

SPECIAL TEST: (choose one test for each domain)

  • Apley scratch test -> for the shoulder ROM
  • Infraspinatus -> Resisted ER w arm by the pt’s side
  • Supraspinatus -> Empty can test = Jobe’s test
  • Teres minor -> Hornblower’s test
  • Subscapularis -> Lift off test
  • Impingement syndrome -> Painful arc, Neer sign, or Hawkin’s test
  • Biceps -> Yergason’s test, or Speed’s test
  • AC joint -> Cross arm test
  • Shoulder instability -> Apprehension test

 

NEUROVASCULAR:

Axillary:

  • M -> shoulder abduction
  • S -> lateral shoulder patch

Musculocutaneous:

  • M -> elbow flexion
  • S -> lateral forearm

Median:

  • M -> Ok sign
  • S -> tip of the index finger

Ulnar:

  • M -> fingers abductionadduction
  • S -> ulnar side of the little finger

Radial:

  • M -> wrist extension
  • S -> 1st web space

 

Reflexes:

  • Biceps: C5
  • Brachioradialis: C6
  • Triceps: C7

 

Pulses:

  • Brachial A
  • Radial A
  • Ulnar A

 

JOINT ABOVE (cervical spine) + JOINT BELOW (elbow)

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