The shoulder exam is an examination that can be administered as part of the physical exam and is used to identify potential pathology involving the shoulder.
Begin by washing your hands. Explain the procedure to the patient and gain informed consent to continue.
Begin with observation of the patient.
With the patient still stood, you perform two quick and easy function tests. This involves the patient placing their hands behind their head and behind their back. This checks that they can perform everyday tasks.
Feel over the joint and its surrounding areas for the temperature of the joint. A raised temperature may suggest inflammation or infection in the joint.
Systematically feel along both sides of the bony shoulder girdle. Start at the sternoclavicular joint, work along the clavicle to the acromioclavicular joint, feel the acromion, and then around the spine of the scapula. Feel the anterior and posterior joint lines of the glenohumeral joint and finally the muscles around the joint for any tenderness.
The movements of the joint should start being performed actively. Ask the patient to bring their arm forward (flexion), bend their arm at the elbow and push backwards (extension). Bring their arm out to the side and up above their head (abduction). Flex the elbow and tuck it into the side and move the hand outwards (external rotation). And finally see how far they can place their hand up their back (internal rotation).
Once all of these movements have been performed actively, you should perform them passively and feel for any crepitus whilst moving the joints
There are three special tests which can be performed on the shoulder. These are:
- the impingement test,
- the apprehension test
- and the scarf test.
The impingement test is performed by placing the shoulder out at 90 degrees with the arm hanging down, press back on the arm and check for any pain.
The apprehension test is similar but the arm is facing upwards and push back on the arm; the patient may be apprehensive about the movement as the joint feels unstable.
The scarf test is performed with the elbow flexed to 90 degrees, placing the patient's hand on their opposite shoulder and pushing back. Again look for any discomfort.
An extension to this station may be to assess each rotator cuff muscle individually.
On completion, thank the patient for their time and wash your hands.