Shoulder examination introduction shoulder disorders are can be broadly classified into the following types. Clinical examination and manual therapy of the shoulder and. Many similar tests have been described by different people and given different names. Physical examination of the shoulder musculoskeletal key.
Laxity, instability, and superior labral anterior and posterior slap lesions t. How i do a 5 minute comprehensive examination of the. Clinical trials expertise has led the division to national and international prominence. May 15, 2000 shoulder pain is a common complaint in family practice patients. Jan 05, 2017 how to examine the shoulder, including the following. The key principle with this phase of the shoulder examination is symmetry. Shoulder instability failure to keep humeral head centered in glenoid dislocation complete disruption of joint congruity or alignment subluxation partial or incomplete dislocation laxity. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Performing the exercises two to three days a week will. There are over a hundred tests described for examining the shoulder. Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. Pdf examination of the shoulder george murrell academia. Feb 22, 20 shoulder examination for orthopedic students.
At the conclusion of this program, the learner will be able. This twoday program is an introductory course that establishes baseline knowledge of anatomy and biomechanics of the shoulder girdle. You may be more familiar with the term frozen shoulder to describe this condition. The shape, position and function of each shoulder should be relatively similar. Briefly explain to the patient what the examination involves.
Data sources structured search in medline, embase, and cinahl from their inception through may 20. Importance rotator cuff disease rcd is the most common cause of shoulder pain seen by physicians. They should be used selectively and appropriately to examine the shoulder components of which the clinician is suspicious. Shoulder pain is a common presenting symptom in musculoskeletal clinics. This is particularly true in the examination of the overhead athlete. It is the role of primary care, orthopaedic and rheumatological clinicians to assess complaints relating to the shoulder in a systematic manner. Primary care sports medicine fellow steadman hawkins clinic of the carolinas. This video produced by students at oxford university medical school in conjunction with the faculty demonstrates how to perform an orthopaedic examination of the shoulder joint. The etiology is most of the time traumatic and related either to sport or accidents. A stepbystep guide to performing shoulder examination in an osce setting, with an included video demonstration. Procedures and possible findings for physical examination of the shoulder are categorized and described. You should ensure you are able to perform this confidently. Ronquillo, md, fpoa, zoltan szomor, mbbs, phd, fracs, and george a.
Introduce yourself, confirm the patients name and date of birth. The unique anatomy and range of motion of the glenohumeral joint can present a diagnostic challenge, but a proper clinical. How i do a 5 minute comprehensive examination of the shoulder. Also, many different tests have been described by the same person. The ottawa knee rules a useful clinical decision tool. Complaints of anteriorlateral pain, compensatory shoulder shrugging with overhead motion, gross functional disabilities, constant achiness in the shoulder, night pain, pain that wakes that patient during sleep, and patient age of 40 or greater may be indicative of a rotator cuff tear.
General principles musculoskeletal exam performed if symptoms i. Check out the shoulder examination mark scheme here. Objective to perform a metaanalysis to identify the most accurate clinical examination findings for rcd. Rotator cuff integrity rupture of any of the musculotendinous units associated with the shoulder may be a cause of pain, weakness. With dvd containing narrated footage of examination techniques.
Figure 2 more clearly identifies the 3 joints of the shoulder sc, ac, gl enohumeral as well as other bony landmarks. Clinical examination of the shoulder girdle a shoulder examination or shoulder exam is a portion of a physical examination used to identify potential pathology involving the shoulder. The examination will assist in diagnosis of impingement syndrome, rotator cuff tears, and biceps tenosynovitis. Start by finding the long biceps tendon in between the greater. Shoulder physical examination examination the glenohumeral joint is the most mobile joint in the body, but the large multidirectional range of motion is a tradeoff for joint stability. Shoulder frozen shoulder test adhesive capsulitis test.
The tradeoff for this freedom of motion is a relative lack of stability, which makes the. The range of the internal and external rotation of the shoulder is of clinical and functional importance. The following questions relate to the impact of your arm, shoulder or hand problem on playing your musical instrument or sport or both. Bobby masocol md primary care sports medicine fellow steadman. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. Skillful examination of the shoulder is an integral part of this evaluation and is necessary to generate an appropriate differential diagnosis and to help determine whether advanced imaging is needed. The protocol is based on prior literature and the clinical experience of the authors. The material on this website is designed to support, not replace, the relationship that exists between ourselves and our patients. Stabilize the scapula, and slide the humeral head anteriorly and posteriorly within the glenoid fossa to evaluate. Dec 18, 2015 shoulder examination is a practical skill which requires background knowledge of anatomy, of normal shoulder function and of abnormalities affecting the shoulder. The view from the side detects any recurvatum or lack of complete extension. How i do a 5 minute comprehensive examination of the shoulder c.
One of the examiners hands stabilizes the shoulder girdle scapula and clavicle while the other grasps the proximal. A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. The evaluation of patients with shoulder dysfunction or pain can be difficult. Deformity of the joint and fractures and dislocations are usually obvious figure 37a,b. Division of rheumatology mcmaster faculty of health sciences. Acute shoulder injuries in adults american academy of.
When assessing shoulder pain, a structured physical examination, as directed. The likely diagnosis will have been derived from the history. If patient feels instability, they typically will balk when the test is performed laxity test o have the patient in the supine position. Gp assessment of the shoulder keith littlebury msc grad dip phys. Reinold, dpt, atc, cscs2 brian cole, md, mba3 1champion sports. Hawkinskennedy test positive in shoulder impingement flex the shoulder to 90 o with the elbow flexed to 90 o. Please answer every question, based on your condition in the last week. The exam for shoulder pain stanford medicine 25 youtube. Ask the patient to place the hand of the side you are examining on the contralateral shoulder and then push the elbow superiorly to compress the acromium against the lateral end of the clavicle. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting. Meyers, md from orthopaedic research of virginia, richmond, virginia. In each case it is important to be familiar with some basic examination tools that can help us confirm the presence of a shoulder lesion. Clinical examination of the shoulder joint complex kevin e. Structural diagnosis of rotator cuff tear requires imaging.
Tendinitis supraspinatus supraspinatus tendinitis is a common inflammatory condition of the shoulder that causes anterior shoulder pain. The examination of all joints follows the general pattern of look, feel, move as well as. The division of rheumatology is researchintensive, with emphasis in rheumatoid arthritis, osteoarthritis, and osteoporosis. The examiner holds the patients scapula spine forward with his index and middle fingers. The aim of this study is to present those clinical tests that we have found by research and practice to be helpful when. This video is brought to you by the stanford medicine 25 to teach you the common causes of shoulder pain and how to diagnose them by the physical exam. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuff. This shoulder conditioning program should be continued for 4 to 6 weeks, unless otherwise specified by your doctor or physical therapist. Frozen shoulder, aka adhesive capsulitis, is a condition characterized by stiffness and pain in the shoulder joint.
The necessary skills can be developed by examining colleagues or patients. Currently, almost without exception, there is a lack of clarity with regard to whether common tests used in clinical examination are useful in differentially diagnosing pathologies of the shoulder hegeduset al. Inspection of structures eg, of the clavicle, acromion, acromioclavicular joint, scapula, and scapular spine. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuffspecific testing biceps testing.
Pdf current concepts in shoulder examination of the overhead. Shoulder pain leads many patients to see a primary care physician. But frozen shoulder and adhesive capsulitis are actually two separate condi. Gp assessment of the shoulder keith littlebury msc grad dip phys extended scope physiotherapist camden cats service. Shoulder exam stanford medicine 25 stanford medicine. Instability the common disorders arise from diseases of the following structures. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration. This article focuses on examination of the rotator cuff. A patients guide to adhesive capsulitis introduction many adults mostly women between the ages of 40 and 60 years of age develop shoulder pain and stiffness called adhesive capsulitis.
Subjects covered in the video include frozen shoulder, rotator cuff tears, subacromial impingement and. Rotate the shoulder externally by pushing the forearm posteriorly. Shoulder anatomy figure 1 demonstrates muscular landmarks, including rotator cuff attachments. For example, a history of acute trauma to the shoulder with the arm abducted and externally rotated strongly suggests shoulder subluxation or dislocation and possible glenoid labral injury. Initial assessment of the injured shoulder pdf 431kb.
Numerous clinical tests described for shoulder examination. The complex structure of the shoulder, with its variable pathological conditions of rotator cuff disease, degenerative joint disease, and type ii slap lesions, makes clinical examination and assessment difficult for both new and experienced practitioners. Those are great, but the real challenge when working with someone with shoulder impingement isnt figuring out that they have shoulder pain, thats fairly obvious. The shoulder exam overview of anatomy shoulder created by 3 bony structures. Shoulder pain is one of the most common complaints in the outpatient setting. Pdf examination of the shoulder complex has long been described as challenging. Bobby masocol md primary care sports medicine fellow. Most of the clinical examination for shoulder impingement involves provocative tests. Place 1 hand behind the back and push out against resistance. Discussion covers initial impressions, inspection, palpation, range of.
In the clinic, the axial rotational range is used in shoulder examinations to test for. Clinical examination of the shoulder complex jospt. In each case it is important to be familiar with some basic examination tools that can help us confirm the. Starting at the cervical spine, including the brachial plexus, and encompassing the multiple articulations of the shoulder. Careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. Explain the examination, obtain consent and a chaperone and then proceed to wash hands. Pain eliminated by local anaesthetic injection into the subacromial bursa. If you play more than one sport or instrument or play both, please answer with respect to that activity which is most important to you.
The supraspinatus inserts mos t superiorly, followed by the infraspinatus, teres minor, and subscapularis. Clinical examination of the shoulder complex martin boublik, md richard i. Shoulder impingement 3 keys to assessment and treatment. Passive abduction in internal rotation in the scapula plane painful. The shoulder examination, along with all other joint examinations, is commonly tested on in osces. Drawer test the patient is seated with the forearm resting on the lap and the shoulder relaxed. Orthopedic exam special tests for physical therapy. University of utah department of physical therapy studentrun pro bono clinic rom. Physical exam and evaluation of the unstable shoulder. Table 4 provides details of the muscles of the shoulder and figure 38ad illustrations of the anterior and posterior bones and muscles of the upper limb. Jun 25, 2008 the affected shoulder is held at 80120 of abduction, 020 of forward flexion and 030 of external rotation. Pdf physiotherapists recommendations for examination. How to examine the shoulder merck manual professional. A resource for gps and other medical professionals.
Shoulder pain and rotator cuff disease the jama network. Examination of the shoulder joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient to expose their shoulders fully inspection look anterior, lateral, and posterior asymmetry or deformity scars or skin changes muscle bulk palpate temperature. Disabilities of the arm, shoulder and hand dash instructions this questionnaire asks about your symptoms as well as your ability to perform certain activities. Examination of the newborn is usually performed by a midwife who is qualified in the newborn and infant physical examination screening programme nipe. Shoulder disorders are can be broadly classified into the following types. The lack of stability makes the shoulder more susceptible to a large spectrum of injuries, especially with overhead activities.
After your recovery, these exercises can be continued as a maintenance program for lifelong protection and health of your shoulders. After answering which hand is most dominant and which shoulder is being evaluated, the questions are as follows. The shoulder joint is one of the more mobile joints in the body and restriction can have a significant effect on functional ability 1, 2. Nov 27, 2017 the simple shoulder test begins with instructions to answer the questions based on shoulder comfort and function as they have affected lifestyle and ability over the prior week. All osce notes and osce examinations are downloadable for medicine osce exam finals revision. Pdf physical examination of the shoulder researchgate. Other causes are degenerative joint disease and arthritis. Youll be expected to pick up the relevant clinical signs using your examination skills. Introduction shoulder pain is the third most common musculoskeletal condition given by patients as a reason for encounter to general practitioners gps in australia, described at 1. Acute shoulder injuries in adults are often initially managed by family physicians. Examination of shoulder pathologies ce course for therapists. Clinical examination and manual therapy of the shoulder and shoulder girdle diagnose precisely.
Ask whether the patient is in any pain, especially in the shoulder area, and ask them to report if they have any pain at any point of the examination. Swelling of the shoulder joint may be visible due to a joint effusion, or synovial thickening. Meyers, md from orthopaedic research of virginia, richmond, virginia careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. Some differences can occur due to shoulder dominance. Examination of the biceps tendon and superior labrum anterior and posterior slap lesions 7. Pdf this article summarizes the overall assessment of the shoulder joint and seeks to help direct clinicians to diagnose shoulder pathology. Internally rotate shoulder to near maximum holding the wrist by passively lifting the dorsum of the hand away from the lumbar spine then supporting the elbow, tell patient to maintain position and release the wrist while looking for a lag. However, regional variations may occur depending on the availability and qualifications of the staff available.
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