Clinical examination of shoulder joint (orthopedics posting) I do not own this file. Courtesy to Dr Madhusudhan, BBH Orthopaedics

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EXAMINATION OF SHOULDER JOINT
CHIEF COMPLAINTS;–
H/o pain ,
H/o deformity,
H/o giving away,
H/o any abnormal swelling (exostoses)
HISTORY OF PRESENTING ILLNESS;-eloborate on chief complaints
ADL;- any limitation in combing hair, holding support in bus , putting on shirt or brassire ,
etc
Negative H/o:- H/o trauma, / intramuscular injection(deltoid contracture) / Constitutional
symptoms.(TB) / H/o fever / H/o Seizures/ H/o voluntary reductions(multiaxial instability) /
H/o Neurovascular deficiency / H/o sporting events .
LOCAL EXAMINATION ;–
Attitude & deformity ;– In most conditions like dislocation # clavicle, # SOH, patient
holds the limb with opp. Hand supported
In elbs palsy – flexion – Adduction– Intn rotation- at the shoulder
In deltoid fibrosis – arm is held in abduction
INSPECTION;-
1.Examination Anteriorly – look for deltoid bulge, Supra & Infra clavicular fossa ,AC
joint bulge, Pectoral bulge , Loss of roundness of deltoid, Any stooping / flattening /
scars / sinuses .
2. Examination from side – Look for deltoid bulge / wasting/ scar / sinuses .
3 .Examination from top – AC joint elevation, angle of acromion/ suprascapular
wasting.
4. Examination from back – any stooping / AC joint elevation / scapular broadening,
Angle of scapular, Level of scapula, Spine of scapula
1. Bony arches – Look for clavicle / sterno clavicular ,/ AC clavicular / Scapula
PALPATION : -
Superficial: – Local rise in Temp. / hypo – hyper -aesthesia / Supl tenderness
(keloid)_
Deep Palpation –fibrosis of deltoid,/ Tenderness at AC joint,/ clavicle, /scapula
Bony palpation;–
a) Clavicle – Look for irregularity, abnormal mobility, Crepitus
b) Sterno Clavicular & Ac Clavicular jt. Tenderness, and its relative positions
c) Upper end humerus – palpate for greater tuberosity, metaphyseal area for thickening
(Medial epicondyle shows direction of the head, lateral epicondyle shows the
direction of greater tuberosity )
d) Scapula examination – look for spine, angle, acromion , borders, levels

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MOVEMENTS;-
Flexion 0 – 120degpure GH.(150 deg
GH/AC/SC/ST.)(180 with
lumbar hyperextn
Pect – major/ minor
Etn. 0 – 55 L dorsi
Add 0 Subscapularis
Abd 0 – 150 GH-90deg)(150 deg
GH/AC/SC/ST)
15 deg. Supra spinitus
15 – 90 deg. – deltoid
ER 70 – 90 Infra spinitus, t minor,
posterior fibers of delta
IR 0 - 70 Sub scapularis, P major
Scapular Protraction
Scapular retraction
MEASUREMENTS:-
1. Length of the arm – linear; – angle of accromiom to lat. Epicondyle
Circumferential; – around the axilla(girth) and mid arm to – look
for wasting .
Examination of Neuro Vascular and Lymphatic system ;- look for regimental badge
sign (axillary nerve injury you will tend to miss in dislocations be careful )
Special tests: -
1. SHOULDER DISLOCATION TEST :-Hamilton ruler test / Callaway test/ Dugas
test.
2. IMPINGMENT TESTS:-Neers test/Hawkins kennedy test.
3. TESTS FOR ROTATOR CUFF INTEGRITY :- Jobe empty can test, Drop arm test,
Belly press test /lift off test.
4. TESTS FOR APPREHENSION TESTS :-Apprehension test/relocation test
5. Test for brachial plexus – Axillary, radial, thoracic inlet syndrome, Yergason test,
drop arm test
6. TEST FOR SLAP LESION :-O BRIEN TEST(Forward flex shoulder to 90+addn15
deg+IR+elbow straight +thumb pointing downwards.
CRANK TEST – Compression rotation testfor slap
7. TESTS FOR ACJ :-horizontal adduction test
8. TESTS FOR BICEPS TENDON :- speed and yergason test
DIAGNOSIS;- ANATOMICAL- Which part of shoulder, humerus, glenoid ,
tuberosity , Surgical neck, or any tendon surrounding the joint is involved etc
PATHOLOGICAL-Dislocation, tendinitis, tendon rupture, impingement etc
INVESTIGATIONS :-
Laboratory – Hb,WBC,TCDC,ESR,
Radiological and Special investigations – Xray and MRI

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SELF NOTES