Exam Summary

1. Introduction

  • Introduce yourself and the exam
  • Ask them to expose their shoulder - watch how the patient undresses
  • Ask if the patient has any pain
  • Hand hygiene

2. Observations

  • Temperature
  • Heart Rate
  • Respiratory Rate
  • Blood Pressure

3. General Inspection

Look for:
  • Swelling
  • Symmetry
  • Redness
  • Scars
  • Muscle wasting (Deltoid, Trapezius)
  • Winged Scapula

4. Palpation

Start with the unaffected shoulder
  • Sternoclavicular joint
  • Along the Clavicle
  • Acromioclavicular joint
  • Coracoid Process
  • Anterior Glenohumeral joint line
  • Long Head of Biceps tendon
  • Insertion of Supraspinatus
  • Spine of scapula
  • Medial border to inferior pole of scapula

5. Movements of the shoulder

  • Abduction - normal range 180º
  • Adduction - normal range 50º
  • Flexion - normal range 180º
  • Extension - normal range 70º
  • External rotation - Ask the patient to place their elbows by their hips and rotate their arms outwards. Normal range 90º
  • Internal rotation (hand up back) - should be able to touch the lower border of the scapula or T7.

6. Special Tests

a. Glenohumeral joint

  • Fix inferior pole with one hand
  • Passively abduct shoulder
  • The scapula should only rotate after the shoulder has abducted beyond 45º

b. Shoulder stability

i. Clunk test

  • Ask the patient to lie with the arms abducted at 90º
  • Fully externally rotate the shoulder
  • A grinding sensation or noise indicates instability and increased risk of dislocation

ii. Apprehension test

  • Abduct arm to 90º
  • Flex elbow to 90º
  • Externally rotate the shoulder and look for apprehension

c. Acromioclavicular Joint

i. Scarf Test

  • Passively adduct a flexed elbow (90º) across the body

d. Rotator cuff muscles

i. Empty can

  • Abduct shoulders to 90º
  • Move arms so they are 30º infront of the patient
  • Assess abduction strenght in "full can" can "empty can" positions

ii. External Rotation against resistance

  • Ask the patient to place their elbows by their hips and rotate their arms outwards. Resist this movement.

e. Winged Scapula

  • Ask the patient to push against a wall

f. Functional

  • Hands behind neck
  • Hands behind back

7. Other Examinations


8. Conclude

  • Thank the patient and offer assistance

See Also

Geeky Medics - Shoulder Examination - OSCE Guide


Talley and O'Connor Clinical Examination - 7th edition pp309-12