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

shoulder 1

  • 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 extensionelbow 4
      • 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)

 


Download the PDF version: here

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