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    Examination of The Shoulder

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    Anonymous 9QxPDp
    This document provides an overview of how to examine the shoulder joint. It begins with an introduction to shoulder anatomy and describes examining the skin, soft tissues, bones, range of motion, strength and stability. Key examination techniques are outlined, including inspection, palpation, active and passive range of motion tests, isolated movement assessments, and special tests like the apprehension and sulcus maneuvers. Common differential diagnoses for shoulder pain are also listed. The goal of examination is to localize the source of pathology and distinguish between disorders of the glenohumeral joint, rotator cuff, bursa, instability and referred pain from other structures.

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    Examination of The Shoulder

    Uploaded by

    Anonymous 9QxPDp
    147 views33 pages
    This document provides an overview of how to examine the shoulder joint. It begins with an introduction to shoulder anatomy and describes examining the skin, soft tissues, bones, range of motion, strength and stability. Key examination techniques are outlined, including inspection, palpation, active and passive range of motion tests, isolated movement assessments, and special tests like the apprehension and sulcus maneuvers. Common differential diagnoses for shoulder pain are also listed. The goal of examination is to localize the source of pathology and distinguish between disorders of the glenohumeral joint, rotator cuff, bursa, instability and referred pain from other structures.

    Original Description:

    Presentation on clinical examination of the shoulder joint

    Original Title

    Examination of the Shoulder

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    This document provides an overview of how to examine the shoulder joint. It begins with an introduction to shoulder anatomy and describes examining the skin, soft tissues, bones, range of motion, strength and stability. Key examination techniques are outlined, including inspection, palpation, active and passive range of motion tests, isolated movement assessments, and special tests like the apprehension and sulcus maneuvers. Common differential diagnoses for shoulder pain are also listed. The goal of examination is to localize the source of pathology and distinguish between disorders of the glenohumeral joint, rotator cuff, bursa, instability and referred pain from other structures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    147 views33 pages

    Examination of The Shoulder

    Uploaded by

    Anonymous 9QxPDp
    This document provides an overview of how to examine the shoulder joint. It begins with an introduction to shoulder anatomy and describes examining the skin, soft tissues, bones, range of motion, strength and stability. Key examination techniques are outlined, including inspection, palpation, active and passive range of motion tests, isolated movement assessments, and special tests like the apprehension and sulcus maneuvers. Common differential diagnoses for shoulder pain are also listed. The goal of examination is to localize the source of pathology and distinguish between disorders of the glenohumeral joint, rotator cuff, bursa, instability and referred pain from other structures.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 33
    At a glance
    Powered by AI
    The key takeaways are that the shoulder is a very mobile but unstable joint, and a thorough examination involving inspection, palpation, and assessment of range of motion and special tests can help identify underlying pathologies causing shoulder pain.

    The main components of the shoulder joint are the glenohumeral joint, acromioclavicular joint, and rotator cuff muscles including the deltoid, supraspinatus, infraspinatus, subscapularis and teres minor muscles.

    The key steps in examining the shoulder are inspection of the skin and soft tissues, palpation of bony landmarks and soft tissues for tenderness, assessment of active and passive range of motion, and performance of special tests like the impingement, apprehension, and sulcus tests.

    EXAMINATION OF THE

    SHOULDER

    OLADUNNI E. KAYODE (MBChB. V)


    OAUTHC ILE-IFE.

    OUTLINE

    INTRODUCTION
    ANATOMY
    EXAMINATION
    DIFFERENTIAL DIAGNOSIS OF SHOULDER
    PAIN
    CONCLUSION

    Introduction

    The shoulder joint forms an important


    part of the human pectoral girdle.It is a
    very mobile and highly unstable
    joint.Shoulder dislocation and pathologies
    are common experience in clinical
    practise ,hence the need to have a good
    knowledge of shoulder examination.

    Anatomy

    Shoulder Muscles Movements

    Fwd Flex - Deltoid, Pec maj, Coracobrach, Biceps

    Extension -Deltoid, Teres maj, Teres min, Lat dorsi,

    Abduction - Deltoid, Supraspin, Infraspin, Subscap,

    Adduction - Pec maj, Lat dorsi, Teres maj, Subscap

    Int rotation - Pec maj, deltoid, Lat dorsi, Subscap

    Ext Rotation - Infraspin, Deltoid, Teres min

    Examination

    Greeting, introduction, Obtaining


    permision
    Look
    Feel
    Move
    Compare
    Examination is most easily & best
    performed if the px is standing & his/her
    shirt & vest removed.

    LOOK

    WITH PX STANDING, look both in front &


    behind.
    Look- @
    Skin
    Soft tissue
    Bone

    Skin

    ForScars
    Swellings
    Erythema
    Sinuses (axilla)

    Soft tissue

    Deltoid wasting- inc angulation of


    shoulder, commonly due to damage to
    the axillary nerve.
    Supraspinator & infraspinator wastingsee hollows above & below the scapular
    spine. Due to tear of the rotator cuffs
    Rupture of the long head of biceps- see
    bulge in the upper arm when elbow is
    flexed.

    Bone

    Subluxed acromio-clavicular joint- hump


    in the distal end of clavicle.
    Ant dislocation of shoulder- loss of
    rounded contour.
    Dislocation- bulge (humerus) in front of
    shoulder, look out for this.

    Feel
    Be careful not to elicit inappropriate
    tenderness & cause discomfort....be
    gentle!
    Referred or LOCAL?
    EPOULETTE SIGN
    Test to diff referred from local pain. A test of
    pain localisation.

    Localisation in the
    shoulder

    Shoulder complex- problems usually arise


    from either
    Glenohumeral joint,
    Acromio-clavicular joint,
    Rotator cuff + subacromial bursa.
    Aim is to distinguish btw them.

    Feel

    Skin- for heat


    Sensations- soft touch, check distally.
    Test the outer & inner side of the arms,
    medial & lateral side of hand

    Soft tissue

    FEEL
    Trapezius Ms for tenderness- common in
    referred pain from neck.
    For tenderness along the margin of
    acromion suggest problem with the cuffs

    Bone

    Clavicle- feel along its margin, for


    tenderness particularly @ the AC joint
    Acromion- palpate its outline for
    tenderness, subacromial bursa

    MOVE

    1.

    2.

    3.

    4.

    ACTIVE & PASSIVE.


    ACTIVE
    Pxs asked to put her hand behind her head & later
    @ the back. Record range of movt.
    Standing behind px, ask her to place arm in the
    plane of the scapular (arm lat & 30 forward), & then
    vertically over the head.
    There should be scapulohumeral rhythm- aBduction
    (10% for 20%), in 2nd movt both should move
    together.
    if there is a catch, px should localize it. If acromial its
    an impingement.

    Isolated Active Movement

    Abduction
    Observe for hesitancy and break in
    smooth rhythm and note the point at
    which pain is detected
    Place your hand on the shoulder to detect
    crepitations originating from subacromial
    region due to degenerative tendinitis of
    rotator cuff.

    Difficulty initiating abduction- Rotator


    cuff tear
    Painful arc from 60-120 Consider rotator
    cuff tendinitis
    Painful arc from 140-180:Consider a
    painful high arc,Osteoarthritis of the
    Acromioclavicular jt

    Adduction
    Instruct the patient to bring his hand
    across the chest as in reaching for the
    opposite shoulder
    Normal value is 45 deg.
    Flexion and extension
    Ask the patient to lift both arms forward
    and then backwards.
    Normal value is 180 of flexion and 45 of
    extension

    External rotation
    With the elbow maintained by the side
    and forearm pointing straigthforward,
    instruct the patient to move the forearm
    away from the body.External rotation is
    about 45
    Internal Rotation
    In the position above, instuct the patient
    to bring the fore arm towards the
    abdomen.Internal rotation is about 55

    PassiveWith arm @ rest


    Elbow is flexed @ 90, & hand straight
    forward.
    Put hand pxs shoulder
    With the other hand, gently turn the
    forearm outwards exteriorly, this rotates
    the shoulder
    Arthritis- crepitus @ Glenohumeral joint
    Capsulitis- pain & stiffness (frozen
    shoulder)

    Rotation
    Flex the patients elbow with the forearm
    supported by the examiner, maintain the
    elbow by the side of the body,internally and
    externally rotate the shoulder using the
    forearm as a lever.
    Adduction
    Anchor the patient by placing the hand
    across the top of the shoulder,adduct the
    upper arm across the front of the body,
    noting the range of motion.

    Flexion and Extension


    Anchor the scapular by placing the hand
    across the top of the shoulder, grasp the
    patients upper arm just above the elbow
    and passively flex the shoulder by
    bringing the upper arm anteriorly. Bring
    to neutral position and extend. With
    scapular anchored, true glenohumeral
    flexion is only 90, while true
    glenohumeral extension is 45

    Power

    Deltoid:
    Test abduction against resistance. Axillary
    nerve palsy can result in decreased
    deltoid power.There is also loss of
    sensation in the regimental badge area of
    the shoulder.
    Serratus anterior: Pushing against the
    wall may demonstrate winging of the
    scapular secondary to palsy of the long
    thoracic nerve of Bell.

    stability

    Thumb down test


    Apprehension test
    Sulcus test

    Thumb down

    For impingement & inflammation in the


    subacromial bursa.
    Flex hand to 90 in scapular plane, with
    arm held straight in this position.
    Push down gently on the arm, such that
    px maintains her position against
    resistance
    A sharp pain in the subacromial area
    indicates impingement.

    Apprehension test

    Test at a jt earlier dislocation.


    With the limb placed above head, gently
    rotate it externally. Or while standing @
    pxs back aBduct to 90 & gently pull the
    elbow posteriorly. Ant dislocation usually
    results. Px WILL ASK YOU TO STOP
    Be gentle, don't dislocate.

    Sulcus test

    Tests laxity in a previously dislocated


    joint.
    With arm relaxed, gently draw down on
    the arm. The humerus drops away from
    the acromion, producing a groove(sulcus)

    Special Tests

    Impingement test- Supraspinatus


    tendinitis
    Resisted supination test: Tell the patient
    to supinate against resistance with his
    elbow flexed(the examiner pronating)Pain in the bicipital groove signifies
    bicipital tendinitis
    Test for rotator Cuff tear: Ask px to
    abduct and maintain the arm at
    90.Attempt to push down both hands
    from behind.The side with the pathology
    gives way.

    Drawer test of Gerber and Ganz for


    dislocations.
    Examination of the neck(joint above) and
    the elbows(joint below)
    Assess the neurovascular status of the
    upper limb.

    Differential Diagnosis Of Painful


    Shoulder

    Joint disorders- Glenohumeral arthritis,


    Acromioclavicular arthritis
    Instability- Dislocation, Subluxation
    Rotator cuff disorders- Tendinitis,Rupture
    Capsulitis- Frozen shoulder
    Referred pain-Cervical spondylitis, cardiac
    ischaemia, mediastinal pathology
    Bone lesions- Infections , tumours
    Nerve injury-Suprascapular nerve
    entrapment

    Conclusion

    With proper knowledge based


    examination of the shoulder, a lot could
    be discovered about the various
    pathologies of the shoulder and help in
    the management of the patient.

    THANKS.....

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