Shoulder examination
Look
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From the front, side and above
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Asymmetry, scars, deltoid wasting, SCJ or ACJ deformity, swelling of the joint
From behind
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Look and feel for rotator cuff wasting, scapula shape and situation e.g. winging, Sprengel shoulder etc
Feel
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SCJ to the ACJ and acromion
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Greater and lesser tuberosity, feel for rotator cuff defects
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Glenohumeral joint: anterior and posterior aspects
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Biceps tendon/bicipital groove
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Spine of scapula
Move
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ALWAYS EXAMINE THE CERVICAL SPINE FIRST
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Move both arms at the same time. Active then passive ROM.
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Quick screening test: "Arms above the head and behind the back "
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Flexion
:
0-180
o
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Abduction
:
0-180
o
check for painful arc and watch the scapulothoracic rhythm
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If restricted then repeat with the scapula fixed to check for the amount of glenohumeral movement
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Internal rotation: T4
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External rotation
:
70
o
Feel for crepitation during motion
Special tests
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1. Impingement
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Neer's sign:
Hold scapula down, pronate forearm and flexion will cause pain
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Hawkin's test:
Flexion to 90
o
internal rotation will cause pain
Hawkins Test
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Neer's test:
Pain caused by Neer's test eliminated by local anaesthetic injection
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Scarf test:
forced cross body adduction in 90
o
flexion, pain at the extreme of motion indicative of ACJ pathology
Scarf Test
2. Rotator cuff
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