Shoulder exam

Question 1

What is the role of the glenohumeral ligament?

Answer 1

• prevent humeral head from displacing anteriorly

Question 2

What are the different ligaments around the shoulder joint?

Answer 2

• glenohumeral
• coracohumeral
• coracoacromial
• coracoclavicular

Question 3

Name the different rotator cuff muscles. Where do they attach and what movements are they responsible for?

Answer 3

1. Supraspinatus: attaches to greater tubercle
   - responsible for external rotation and initiating abduction (first 15° of movement)
2. Infraspinatus: attaches to greater tubercle
   - responsible for external rotation
3. Teres minor: greater tubercle
   - responsible for external rotation
4. Subscapularis: attaches to lesser tubercle
   - responsible for internal rotation

Question 4

What muscle is usually responsible for painful arc? When is this pain usually felt and why?

Answer 4

supraspinatus

- pain usually occurs around middle of abduction when the affected area is in contact with the acromion

Question 5

Name bursae around the shoulder joint. Which one is most commonly associated with shoulder pain?

Answer 5

1. sub scapular
2. subcoracoid
3. subacromial

Subacromial bursitis is a common cause of shoulder pain

Question 6

What are the steps in examination of the shoulder?

Answer 6

1. introduction
2. preparation
3. look
4. feel
5. move
6. special tests
7. function
8. summary + close

Question 7

How should the patient be positioned?

Answer 7

Sitting/standing (depending on part of examination you are doing)
- remove any clothes obscuring the shoulder

Question 8

What are you looking for when assessing the shoulder?

Answer 8

1. look anteriorly and posterioly
2. skeletal abnormalities - varus or valgus deformity, is there a step that could indicate dislocation?
3. muscle bulk - particularly deltoid, compare both sides
4. swelling - oedema, bursitis
5. skin - scars, redness, psoriasis etc

Question 9

What are you feeling for when assessing the shoulder?

Answer 9

1. temperature
2. joint line - feel along the clavicle and the acromioclavicular joint, around the joint capsule and along the scapular spine
3. swelling/effusion
4. tense the bicep against resistance to feel for proximal tendon

Question 10

What movements are you performing when assessing the shoulder? In which ways should these movements be assessed?

Answer 10

• flexion + extension, abduction + adduction, internal and external rotation
  1. active
  2. passive
  3. resisted

Question 11

If there is limited ROM in active movement, but you are able to elicit full range of movement passive without pain, what does this indicate?

Answer 11

Muscular pathology

Question 12

What are the different special tests for the shoulder?

Answer 12

1. Reverse empty can tests
2. lower back push
3. Winging scapula
4. Speed test
5. Scarf test
6. Neer’s test
7. Hawkin’s test

Question 13

What is the reverse can test and what is it assessing?

Answer 13

• assessing supraspinatus
  1. ask the patient to hold their arms out in front
  2. ask them to point their thumbs towards the ground as if they’re pouring a drink away
  3. push down on their arms, asking them to resist
  4. any pain or weakness suggests a supraspinatus pathology

Question 14

What is the lower back push test and what is it assessing?

Answer 14

• assessing subscapularis
  1. ask patient to put the back of their hands on their lower back
  2. push hands into back and ask patient to resist by pushing hands away from their back
  3. pain or weakness indicates subscapularis pathology

Question 15

What is the winging of scapula test and what is it assessing?

Answer 15

• assessing serrates anterior
  1. ask patient to push against a wall
  2. see if either scapula ‘wings out’
  3. winging of scapula suggests damage to long thoracic nerve/weakness to serratus anterior

Question 16

What is the speed test and what is it assessing?

Answer 16

1. ask the patient to flex their shoulder forward to 90°
2. arm should be straight and fully supinated
3. ask them to resist you pushing their wrist down
4. pain in the bicipital groove suggests biceps tendon inflammation

Question 17

What is the scarf test and what is it assessing?

Answer 17

1. ask patient to place their hand on the opposite shoulder

2. pain suggests acromio-clavicular joint pathology

Question 18

What is Neer’s test and what is it assessing?

Answer 18

1. ask patient to internally rotate their shoulder
2. passively flex their shoulder to 180° whilst supporting the scapula
3. pain = subacromial impingement

Question 19

What is Hawkin’s test and what is it assessing?

Answer 19

1. passively flex the patient’s shoulder to 90°
2. flex the elbow to 90° (as if looking at a watch)
3. lift the elbow whilst pushing the hand downwards
4. pain = supraspinatus impingement

Question 20

How do you assess function of the shoulder in shoulder examination?

Answer 20

• if patient has weakness/pain ask if they are able to dress themselves
• maybe ask them to demonstrate putting on a coat or lifting themselves out of a chair