A very good step wise approach to basic clinical/orthopedic examination of shoulder for TU/KU MBBS students of nepal.

1. Shoulder Examination
Prepared by:
Sunil Baniya
Student, NAIHS-COM
sanobharayang, ktm
1Shoulder examination/ Sunil Baniya

2. Chief complaints:
 Pain
 Swelling
 Deformity
 Stiffness
 Instability
 Weakness
 Loss of function
2Shoulder examination/ Sunil Baniya

3.  Examination is done either in sitting or standing position with sufficient
exposure.
1. Look :
Front
 Head, neck alignment
 Shoulder symmetry
 Prominent AC joint/ swelling
 Fullness of supra-clavicular area
 Wasting of deltoid
3Shoulder examination/ Sunil Baniya

4.  Axillary area
 Any sinus, scars, swelling
 Arm position
 Small muscles of hand
Side
 Wasting of supraspinatus & infraspinatus
 Winging of scapula
 Swelling, sinus, scars
Shoulder examination/ Sunil Baniya 4
Fig : winged scapula

5. Back
 Wasting of deltoid
 Drooping of shoulder
2. Feel :
a. Temperature:
- Periphery to centre or proximal to distal
b. Tenderness:
 For tenderness palpate over
- Sterno-clavicular joint
- Along clavicle
5Shoulder examination/ Sunil Baniya

6. - Acromio-clavicular joint
- Spine of scapula
- Borders
- Shoulder joint line
- Coracoid process
- Biceps tendon in bicipital groove (arm flexion, elbow flexion at 90°, then
internally/ externally rotate & palpate)
- In axilla palpate humeral head
- Fullness of inferior recess in shoulder effusion
6Shoulder examination/ Sunil Baniya

7. 3. Movement:
 Active movement (passive movement need not to be done)
- Flexion : 0- 160/ 180°
- Extension : 0- 180°
- Adduction : 0-15° (cross arm)
- Abduction : 0-180°
*First 15° = supraspinatus
*15-90° = deltoid
*>90° = serratous anterior
7Shoulder examination/ Sunil Baniya

8. - Internal rotation : 15° (touches inferior border of opposite scapula or thumb
touches upto T5 spine)
- External rotation : 60°
(Rotational movement at various position)
4. Special Tests:
a. Impingement tests:
i) Painful arc test
ii) Neer’s impingement test
iii) Hawkin’s / Hawkin Kennedy test
iv) Jobe’s test/ Empty can test
8Shoulder examination/ Sunil Baniya

9. b. For Rotator cuff tendon tear:
i) Drop arm test
ii) Lift off test/ Gerber’s test
c. For Rotator cuff instability:
i) Apprehension test
ii) Jobe’s relocation test
iii) Sulcus test
9Shoulder examination/ Sunil Baniya

10. Painful arc test:
 for painful arc syndrome
 shoulder pain occurring at 60-120° of arc
 Described when arm is abducted from the side
to fully raised position
 +ve in supraspinatus tendinitis
10Shoulder examination/ Sunil Baniya
During active abduction, the scapulohumeral rhythm is disturbed on the right and
the patient starts to experience pain at about 60 degrees (a). As the arm passes
beyond 120 degrees (b) the pain eases and the patient is able to abduct and elevate
up to the full 180 degrees

11. Neer’s Impingement test:
 Patient standing or sitting
 Hand prone
 Extending at elbow, passively elevate the arm
>90° or above the shoulder
 Other hand of examiner fixes the shoulder
 +ve pain at anterolateral aspect of shoulder =
infraspinatous tendon impingement
Shoulder examination/ Sunil Baniya 11
Fig : Neer's impingement sign

12. Hawkin’s test/ Hawkin Kennedy test:
 Fixing scapula/ shoulder
 Abduction of shoulder at 90°, forward flexion of
elbow
 Internal rotation by examiner by grasping just
below elbow
 Finding : pain at shoulder => Subacromial
impingement
12Shoulder examination/ Sunil Baniya
Fig : Hawkin's test

13. Jobe’s test/ Empty Can test:
 Patient standing
 Arm forwardly flexed at the level of shoulder
 Fully pronate arm into empty can position
 Ask patient to resist downward force applied
 Finding : pain or weakness => Supraspinatus tendon lesion
Shoulder examination/ Sunil Baniya 13

14. Drop arm test:
 Passively forward flex the arm after shoulder
stabilization by other hand
 Bring 90° abduction state
 Let the patient to hold his hand in that position
 Arm drops
 Finding: complete rotator cuff tear
14Shoulder examination/ Sunil Baniya
Fig : Drop arm test

15. Lift off test/ Gerber’s test:
 Patient is asked to stand
 Place his/her one arm behind his/her back with the dorsum of the
hand resting against the mid-lumbar spine
 The examiner then lifts the patient’s hand off the back
 And the patient is told to hold it there
 Finding: Inability to do so=>weakness => rupture of Sub-scapularis
tendon
(Drawback: needs full internal rotation, can not be done when restricted or pain on
doing so)
Shoulder examination/ Sunil Baniya 15
Fig : Gerber's lift-off test

16. Apprehension test:
 Sitting upright position
 Abduct at 90°, forwardly flex, externally rotate, then try
to push shoulder forward extending at the elbow
 Pain
 See patient’s face for apprehension
16Shoulder examination/ Sunil Baniya
Fig : Apprehension test for anterior subluxation or dislocation.
Abduct, externally rotate and extend the patient’s shoulder
while pushing on the head of the humerus. If the patient feels
that the joint is about to dislocate, she will forcibly resist the
manoeuvre.

17. Jobe’s Relocation test:
 Patient supine
 Arm ½ part at the edge of couch
 Externally rotate the forearm
 Pain & apprehension appear first
 Then press down on arm => should relieve pain or apprehension
 Finding: Again pain occurs after release of downward pressure =>
anterior instability
17Shoulder examination/ Sunil Baniya
Fig : Jobe's relocation test

18. Sulcus test:
 For inferior capsular laxity or instability
 Patient sitting arm by side
 Relaxed arm
 Elbow flexed at 90°
 Give downward axial force along the humerus by holding elbow
 Another hand provide grip between acromian, anterior & posterior
18Shoulder examination/ Sunil Baniya
Fig : Sulcus sign

19. OR,
 Arm forward flexion at 90°
 Elbow bent at 90° & internally rotated
 Finding: sulcus appear between acromial arch and humeral head => test the degree
of inferior capsular laxity
Shoulder examination/ Sunil Baniya 19

20. 5. Measurement:
 Take only either of two bony points as reference for girth/bulk of humerus i.e;
acromian or lateral epicondyle of humerus
6. Axillary lymph nodes
7. Cervical spines
8. Distal Neurovascular Status (DNVS)
 Radial pulse
 Sensory examination (autonomous zone of radial, median & ulnar nerve)
 Motor examination (5 groups = C5, C6, C7, C8, T1)
20Shoulder examination/ Sunil Baniya

21.  C5 = elbow flexion
 C6 = wrist extension
 C7= wrist flexion, finger extension
 C8 = finger flexion
 T1 = finger abduction
21Shoulder examination/ Sunil Baniya

22. Thank You
22Shoulder examination/ Sunil Baniya