Shoulder examination

Follow the scheme below:

• Inspection
• Palpation  
• Movement

Before starting

• Introduce yourself
• Explain what the examination entails
• Ask permission to perform examination
• Expose the patient appropriately - from the waist above exposing both the upper limbs, but leaving the underwear on
• Preserve dignity bu using a blanket appropriately 
• Tell the patient to let you know if anything you do is uncomfortable
• Remember - always watch the patients face 

Inspection

General observation

• Does the patient look well?
• Does the patient suffer from any obvious medical conditions? 
• Hands (Rheumatoid arthritis?)

Patient Standing

Remember to inspect from the front, side and above:

• Skin
  • Scars
  • Bruising
  • Skin changes
  • Sinuses
  • Inflammation
• Asymmetry - supraclavicular fossa
• Muscle wasting
  • Especially of the deltoid (disuse or axillary nerve palsy)
  • Periscapular muscles (supraspinatus and infraspinatus) 
• Deformity
  • Sternoclavicular (SCJ) (prominent - subluxation)
  • Acromioclavicular (ACJ) joint (prominent - subluxation or osteoarthritis)
  • Clavicle (old fractures) 
  • Shoulder dislocation
  • Popeye muscle (rupture of proximal portion of long head of biceps)
• Swelling of the joint
• Axilla 

From behind, look for:

• Rotator cuff wasting
• Scapula normmaly shaped and situated (Sprengel's shoulder, Klippel-Feil syndrome)
• Webbing of the skin at the root of the neck (Klippel-Feil syndrome)
• Winging of the scapula (paralysis of the serratus anterior muscle due to long thoracic nerve palsy)