Shoulder Examination

There are pictures and a video clip in the references below that can be viewed in conjunction with the article.

View from rear with patient standing straight and look for lateral symmetry, swelling, position of scapula and signs of muscle wasting.¹

Palpate all over the shoulder girdle, acromioclavicular joint, deltoid and supraspinatus muscles and scapular borders feeling for pain and tenderness, crepitus, effusions, deformities and abnormal muscle development.²

Perform following with patient seated:^1,3

• External rotation - with elbow at right angles and held into side, turn the arm outwards as far as possible.
• Internal rotation - with elbow held into side, raise arm as far as possible up patient's back.
• Internal rotation with 90° forward flexion - support elbow and shoulder with elbow at right angles pointing vertically downwards and palm facing backwards, turn the forearm as far backwards as possible (see Figure 2B)⁴
• Forward flexion - start with arm at patient's side and lift arm forwards and upwards as far as possible.
• Extension - with arm by the patient's side, lift the arm backwards as far as possible.
• Abduction - with arm at patient's side, lift arm away from the body as far as possible, continuing past the horizontal by allowing the shoulder to externally rotate, bringing the hand behind the head.
• Adduction - draw the arm across the anterior chest wall as far as possible.

• Acromioclavicular joint - ask patient to place hand on opposite shoulder. If gentle pressure on the joint elicits pain, this is indicative of acromioclavicular joint inflammation (cross-arm horizontal adduction test).
• Glenohumeral joint - with patient lying on back and arm at right angles over edge of couch, gently push wrist downwards. Patient will complain if joint unstable (apprehension test). With patient lying on back and scapula stable, support elbow and gently move the humeral head up and down in the glenoid fossa by pressing anteriorly and posteriorly on the upper humerus to assess laxity.
• Impingement tests - turn the arm so that the thumb points downwards and lift arm outwards and upwards. With the patient standing and arm abducted at right angles, support the elbow and rotate the forearm internally. In both tests, pain on movement indicates impingement of the rotator cuff.
• Rotator cuffs - with patient seated and elbows tucked into the sides, ask patient to push both outwards and inwards against resistance to assess strength.
• Supraspinatus - ask patient to hold both arms stretched out straight and level with the shoulders and thumbs pointed downwards. Assess strength by asking patient to push the forearms both upwards and downwards against resistance.
• Bicipital groove - palpate bicipital groove with the patient flexing his or her bicep (see picture).²