Shoulder Examination Notes

Examination of the Shoulder Overview

  • Video focuses on documenting the examination of the shoulder using a simulated patient.
  • Emphasizes understanding pain sources: intrinsic (shoulder structures) vs. extrinsic (referred pain from other areas).

Understanding Pain Origins

  • Intrinsic Pain: Direct pain originating from shoulder structures.
  • Extrinsic Pain: Referred pain from:
  • Neck (cervical problems)
  • Mediastinal issues
  • Upper abdominal structures (e.g., liver, spleen)
  • Importance of distinguishing between intrinsic and extrinsic pain through history and examination.

Examination Steps Overview

  1. Look: Inspect the shoulder visually.
  2. Feel: Palpate the shoulder to assess tender areas and abnormalities.
  3. Move: Evaluate the range of motion and functionality of the shoulder.

Checking Gross Function

  • Initial Assessment: Have patient perform common movements to visually assess the shoulder's gross function.
  • Arm lifts in front and side, hands behind head, and internal rotation (thumb reaching back).
  • Stand face-to-face with the patient for clear demonstrations.

Visual Inspection (Look)

  • Skin Assessment: Look for color changes, scarring, or lesions.
  • Shape Assessment: Check for abnormalities in:
  • Sternoclavicular joint (SC joint)
  • Clavicle alignment
  • Acromioclavicular joint (AC joint)
  • Head of the humerus (anterior or posterior dislocation signs)
  • Muscle Assessment: Evaluate the appearance of:
  • Pectoralis major (pect major)
  • Deltoid muscle
    i- Trapezius muscle
  • Ensure normal contour and size of these muscles.

Palpation (Feel)

  • Importance of systematic palpation to identify tenderness linked to specific structures:
  • AC Joint: Pain typically felt at the top of the shoulder.
  • Rotator Cuff: Tenderness felt anterolaterally, near the deltoid's attachment.
  • Biceps Tendon: Pain sensed in the front of the shoulder down to the arm.
  • Shoulder Joint Pain: Diffused pain sensation.
  • Neck Pain: Felt around the back of the shoulder and medial scapula's border.
  • Palpation Points:
  • SC joint, AC joint, greater tuberosity/supraspinatus spot, bicipital groove.

Functional Tests for Rotator Cuff Pathology

  1. NEAR's Sign & Painful Arc: Assessing pain during abduction from 70° to 120°.
  2. Drop Arm Test: Checking for weakness during arm lowering.
  3. Hawken's Sign: Involves internal rotation to check for rotator cuff issues.

Muscle Testing

  • Job's Test: Assessing for supraspinatus function by arm positioning and resistance.
  • External Rotation in Adduction: Testing infraspinatus and teres minor strength.
  • Horner's Sign: Evaluating teres minor strength in similar positions.
  • Lift Off Test: For assessing subscapularis function.
  • Belly Press Test: Patient pushes palm against belly to test subscapularis strength.
  • Behak Test: Assessing the strength and functionality of subscapularis.

Instability Tests

  1. Apprehension Test: Assesses shoulder stability with abduction and external rotation.
  2. Sulcus Sign: Checking for ligament laxity.
  3. Load and Shift Test: Evaluating anterior/posterior capsule laxity.
  4. Jerk Test: Identifying posterior instability through shoulder positioning.

Conclusion of the Examination Process

  • Recap of examination steps:
  1. Gross Function: Movement assessment.
  2. Inspection: Visual assessment of appearance and contour.
  3. Palpation: Tenderness and structure assessment at specific points.
  4. Special Tests: Focused assessments for rotator cuff and instability.
  • Key points formulate a basic but comprehensive approach to shoulder examination.