Physical Exam Shoulder

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Introduction

• Follows the IP-PASS examination methodology
  • Inspection
  • Palpation
  • Passive Range of Motion
  • Active Range of Motion
  • Strength & Neurovascular
  • Special Tests

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Inspection

• Skin
  • Color: erythema, ecchymosis, white, black
  • Trophic changes (altered hair growth, sweat production)
  • Scars
  • Swelling
• Muscle tone: atrophy, hypertrophy
  • Rotator cuff atrophy
• Deformity: asymmetry, rotation, amputation
• Areas of emphasis for shoulder exam
  • Scapular winging?

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Palpation

• Palpate for
  • Effusion
  • Clicking
  • Snapping
  • Crepitus
  • Tenderness
  • Temperature
  • Masses
• Areas of Emphasis
  • Acromioclavicular Joint
  • Sternoclavicular Joint
  • Coracoid Process and proximal Biceps Brachii
  • Insertion of Rotator Cuff (greater tuberosity)
  • Trapezius

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Range of Motion

• Shoulder
  • Abduction: 180 degrees
  • Adduction: 50 degrees
  • Forward flexion: 180 degrees
  • Extension: 50 degrees
  • External Rotation: 90 degrees
  • Internal rotation: 90 degrees
• Elbow
  • Flexion: 150-160
  • Extension: 0

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Strength

• Abduction:
  • 0-90: Deltoid, Superspinatus, Coracobrachialis
  • 90-180: Trapezius, Serratus Anterior
• Adduction: Pectoralis Major, Latissimus Dorsi, Teres Major, Subscapularis
• Flexion: Pectoralis Major, Deltoid, Coracobrachialis
• Extension: Latissimus Dorsi
• External Rotation: Deltoid. Infraspinatus, Teres Minor
• Internal rotation: Deltoid, Teres Major, Subscapularis, Pectoralis Major, Latissimus Dorsi

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Neurovascular

• Motor Nerves:
  • Axillary Nerve: Abduction, External rotation, Shoulder flexion and extension
  • Musculocutaneous Nerve: Shoulder flexion
• Sensory Nerves
  • Needs to be updated
• Dermatomes: C5-T1
  • Deltoid (C5)
  • Thumb (C6, median n)
  • Posterior 1st web space (C6, radial n)
  • Middle finger (C7, median n)
  • Little finger (C8, ulnar n)
  • Proximal medial forearm (T1)
• Deep Tendon Reflexes (C5-C7)
  • Biceps (C5, C6)
  • Brachioradialis (C6)
  • Triceps (C7)
• Myotomes: C5-T1
  • C5: shoulder abduction
  • C6: Elbow flexion Wrist extension
  • C7: Elbow extension
  • C8: Finger flexion
  • T1: Finger abduction
• Vascular
  • Radial pulse
  • Ulnar pulse

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Special Tests

• Subacromial Impingement Syndrome
  • Neers Test
  • Hawkins Test
  • Jobes Test
  • Painful Arc Test
  • Yocums Test
• Rotator Cuff Disease: Subscapularis
  • Lift Off Test
  • Belly Press Test
  • Internal Rotation Lag Sign
  • Bear Hug Test
  • Resisted Internal Rotation Test
• Rotator Cuff Disease: Supraspinatus
  • Drop Arm Test
  • Jobes Test
  • Painful Arc Test
  • Empty Can Test
  • Full Can Test
• Rotator Cuff Disease: Infraspinatus/ Teres Minor
  • External Rotation Lag Sign
  • Hornblowers Sign (Patte Sign]
  • Resisted External Rotation Test
• Proximal Biceps Tendon Injuries
  • Speeds Test
  • Yergasons Test
  • Passive Biceps Subluxation Test
  • Uppercut Test
  • Ludington Test
• AC Joint Disease (Sprain, Arthritis, etc)
  • Crossover Test
  • Obriens Test
  • Resisted AC Joint Extension Test
  • One Finger Test
• Glenoid Labrum (see: Shoulder instability, Biceps)
• Shoulder Instability (General)
  • Internal Rotation Resistance Test
  • Crank Test
  • OBriens Test
  • Passive Compression Test
  • Dynamic Labral Shear Test
• Anterior Instability/ Laxity
  • Apprehension Test
  • Jobe Relocation Test
  • Load and Shift Test
  • Anterior Shoulder Drawer Test
  • Shoulder Fulcrum Test
  • Anterior Release Test
• Posterior Instability/ Laxity
  • Kim Test
  • Jerk Test
  • Posterior Apprehension Test
  • Posterior Shoulder Drawer Test
• Inferior laxity Instability/ Laxity
  • Sulcus Sign
  • Gagey Test
• Multidirectional Instability
  • Sulcus Sign
  • Load and Shift Test
• Thoracic Outlet Syndrome
  • Wrights Test
• Glenohumeral Arthritis
  • Passive Compression Test
• Scapular Dyskinesis
  • Scapular Assistance Test
  • Scapular Retraction Test
  • Lateral Scapular Slide Test
  • Isometric Pinch Test
• Suprascapular Nerve Injury
  • Drop Arm Test
  • Jobes Test
• Winged Scapula
  • Scapular Assistance Test

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See Also

• Internal
  • Clinical Exam (Main)
  • Shoulder Pain (Main)
  • Shoulder Anatomy (Main)
• External
  • https://www.sportsmedreview.com/blog/special-tests-for-the-shoulder-exam/

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