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. In thin subjects the posterior labrum can be clearly seen. 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. Clinical examination and manual therapy of the shoulder and shoulder girdle diagnose precisely. Clinical examination of the shoulder joint complex kevin e. The etiology is most of the time traumatic and related either to sport or accidents. Evaluating for meniscal injury joint line palpation. By gaining an appreciation for the basic structures and functioning of the joint, youll be able to logic your way thru the exam, even if you cant remember the eponym attached to each specific test. Joint examination an overview sciencedirect topics. Shoulder examination instructions examine the shoulder joint of this patient examiner summarise your. Move the transducer medial to the labrum on transverse plane to visualize the spinoglenoid notch. Geeky medics accepts no liability for loss of any kind incurred as a result of reliance upon. As with the shoulder and knee examinations, there are critical steps that form the basis of the examination of the hip joint. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting.
The shape, position and function of each shoulder should be relatively similar. Acute shoulder injuries in adults are often initially managed by family physicians. The muscles surrounding the joint undergo reflex spasm in response to pain originating in the joint, which in turn serves to immobilize the joint and thus reduce the pain. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuff. The exam for shoulder pain stanford medicine 25 youtube. Shoulder exam stanford medicine 25 stanford medicine. Palpate the sternoclavicular joint, the clavicle, the acromioclavicular joint, the acromion, the coracoid process, the head of the humerus, the greater tubercule and the spine of the scapula. If signs warrant, or if suspicion of meniscal lesions or instability arises. Physical examination of the shoulder musculoskeletal key. Nov 28, 2012 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 diagnosisdriven physical exam of the shoulder april 24, 2014. How i do a 5 minute comprehensive examination of the. Therapeutically, joint aspiration in the face of painful effusion relieves the patients discomfort and may facilitate a more accurate joint examination.
In each case it is important to be familiar with some basic examination tools that can help us confirm. Injury to the shoulder joint is followed by pain, limitation of movement, and. If the patient experiences pain or is unable to perform these movements you would then proceed to perform a more detailed examination of the shoulder joint as shown in the full shoulder examination section below. 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. Acute shoulder injuries in adults american academy of. This article presents a systematic approach to diagnosing and managing disorders of the shoulder joint and surrounding structures. The examination of all joints follows the general pattern of look, feel, move as well as. Dec 16, 2012 acromioclavicular joint problem may be elicited by anterior pain with motion and tenderness to palpation over the acromioclavicular joint. During the examination, the patient should be exposed in such a way that the examiner can see the whole of. Your instructor may perform certain maneuvers differently than depicted here.
The shoulder ap view is a standard projection that makes up the two view shoulder series. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. How i do a 5 minute comprehensive examination of the shoulder c. Shoulder pain assessment for the occupational health nurse. 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. The shoulder is often considered a difficult joint to examine, and this is partly due to the large num ber of different clinical tests of shoulder function. The shoulder examination, along with all other joint examinations, is commonly tested on in osces.
The knee examination, along with all other joint examinations, is commonly tested on in osces. A focused history is the most valuable yet least effectively used tool in clinical medicine. During the examination, the patient should be exposed in such a way that the examiner can see the whole of the upper body, both front and back. Checklist for physical examination of the shoulder musculoskeletal block chris mcgrew md, andrew ashbaughdo this handout is for use as a rough guide and study aid.
Examination may report clunking some mild instability sensations. Other orthopedic history surgeries, arthritis, trauma, injuries etc physical exam. All osce notes and osce examinations are downloadable for medicine osce exam finals revision. Check out the shoulder examination mark scheme here. To complete exam to complete my examination i would examine the joint above and joint below, and also do a full neurovascular exam distal to. For each affected joint, please indicate the existing limitation of motion by drawing a lines on the figures below, showing the maximum possible range of motion or by notating the chart in degrees. Ppt shoulder examination powerpoint presentation free to. The joint is sensitive to pain, pressure, excessive traction, and distension. The key principle with this phase of the shoulder examination is symmetry. The likely diagnosis will have been derived from the history. 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. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Nov 17, 2016 anyone who has recently had an anterior dislocation of the shoulder joint or has anterior instability will find this position uncomfortable. I have included detailed descriptions of the shoulder, knee, and low back examinations as these are the most commonly affected areas.
Again, the injured shoulder should be compared with the uninjured shoulder figure 2. Shoulder disorders are can be broadly classified into the following types. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration. It is the role of primary care, orthopaedic and rheumatological clinicians to assess complaints relating to the shoulder in a systematic manner.
Aug 24, 2015 do not perform any examination or procedure on patients based purely upon the content of these videos. Oct 04, 2010 shoulder examination frequently appears in osces. The arm is abducted to 90 degrees with the elbow also bent to 90. Reinold, dpt, atc, cscs2 brian cole, md, mba3 1champion sports. Within the book, he provided a table to help clinicians distinguish various shoulder conditions. Some differences can occur due to shoulder dominance. Testing of rotator cuff integrity should be part of all shoulder exam.
Briefly explain to the patient what the examination involves. Youll be expected to pick up the relevant clinical signs using your examination skills. Initial assessment of the injured shoulder pdf 431kb. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral. Pdf physical examination of the shoulder researchgate. You should ensure you are able to perform this confidently. Greater and lesser tuberosity, feel for rotator cuff defects. The glenohumeral joint is often referred to simply as the shoulder joint. Mainly 40 to 65 year olds frequently women pain around shoulder, occ. Instability the common disorders arise from diseases of the following structures. Diagnostically, the procedure permits acquisition of synovial fluid for analysis. The examination of all joints follows the general pattern of look, feel, move and occasionally some special tests. The diagnosisdriven physical exam of the shoulder april 24, 2014 carlin senter md, natalie voskanian md, veronica jow md. Ac joint, bicep tendon, and the greater tuberosity of the humerus supraspinatus should be included.
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. The shoulder is a ball and socket joint formed from three bones the clavicle. Shoulder anatomy shoulder history shoulder impingement signs shoulder crossover maneuver hawkins test neer test shoulder instability exam shoulder apprehension test shoulder strength exam drop arm test supraspinatus test french horn shoulder test speeds test yergason test shoulder range of motion apleys scratch test rotator cuff injury. Therefore, if one describes anterior dislocation of the shoulder joint or a frozen shoulder, they are in fact referring to the glenohumeral joint. Keeping these muscles strong can relieve shoulder pain and prevent further injury. The necessary skills can be developed by examining colleagues or patients. The tradeoff for this freedom of motion is a relative lack of stability, which makes the. The practitioner pushes on the elbow, pushing the humeral head further into the joint whilst rotating the shoulder. Shoulder examination a free powerpoint ppt presentation displayed as a flash slide show on id. Primary care sports medicine fellow steadman hawkins clinic of the carolinas. Shoulder pain is one of the most common complaints in the outpatient setting. Other causes are degenerative joint disease and arthritis. Clinical examination and manual therapy of the shoulder and.
Bobby masocol md primary care sports medicine fellow. Clinical assessment of the shoulder sta healthcare. Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. Whole shoulder frozen shoulder superior shoulder ac joint. Goes to wrist reduced gh joint rom active passive capsular restriction erabdir resisted tests pain free. Compound movements are often used as a rapid screening tool for shoulder joint pathology as they test a number of the rotator cuff muscles in one go. During this part of the examination, remind the patient to report if they feel any pain. Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Shoulder pain leads many patients to see a primary care physician.
This hip examination contains 21 steps, which compares well with the shoulder 20 step exam and the knee 33 step exam. Discussion thorough history taking including psychosocial aspects and skilled examination are essential. Feb 22, 20 shoulder examination for orthopedic students. With shoulder injuries often whats known as scapulohumeral rhythm is affected how your shoulder blades move in relation to your arms, so your practitioner should also look for this. At the conclusion of this program, the learner will be able. Range of joint motion evaluation chart name of patient client identification number instructions. There are a large number of tests that can be performed in the shoulder examination, many of which may check. Vague shoulder pain with a normal physical examination should increase. 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. Special tests in shoulder examination examination of the shoulder should be performed after the examiner has obtained a careful and thorough history. Place 1 hand behind the back and push out against resistance. Shoulder examination osce guide old version youtube. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable.
Joint aspiration offers both diagnostic and therapeutic benefits when managing joint effusion or inflammation. How i do a 5 minute comprehensive examination of the shoulder. In 1934, in his classic book the shoulder, codman1 was the. Clinical examination of the shoulder complex martin boublik, md richard i. Pain radiates from superior shoulder to lateral neck and upper trapezius pain with reaching, especially across body pain with pushups, bench press, and overhead lifting aching rest pain usually insidious onset no change in shoulder pain with neck rom. Shoulder examination introduction shoulder disorders are can be broadly classified into the following types. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. Remember, if you have forgotten something important, you can go back and complete this. High impact rheumatology joint examination and injection techniques part 1. Bobby masocol md primary care sports medicine fellow steadman. 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. This part of the assessment involves the practitioner looking at the shoulder itself, examining it and the joints above and below elbow and neckupper back. When assessing shoulder pain, a structured physical examination. The ottawa knee rules a useful clinical decision tool.
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