Shoulder Physical Exam

• WIPE, blah blah 🙂
• “Take vital signs”
• Position: standing
• Proper exposure: from the waist up
• General inspection of the patient + surroundings

• Look:
  • Swelling, Skin changes, Scars
  • Muscle wasting
  • Deformities\asymmetry\alignment
  • 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)
  • Flexion\extension
  • Abduction\adduction
  • External\internal 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 abduction\adduction
    • S -> ulnar side of the little finger
  • Radial:
    • M -> wrist extension
    • S -> 1^st web space
  • Reflexes:
    • Biceps: C5
    • Brachioradialis: C6
    • Triceps: C7
  • Pulses:
    • Brachial A
    • Radial A
    • Ulnar A

• Joint above (cervical spine) + joint below (elbow)

Download the PDF version: here