examination of the shoulder

8/14/2019 Examination of the Shoulder

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Examination of the Shoulder

Liem Arinuryanto Lios

Edited by Valentine Ongko


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Anatomy

Anterior View


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Anatomy

Posterior View


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Functions of the Components of the Shoulder

Acromioclavicular joint

Coracoclavicular ligament: controls

vertical stability; restrains superior

and anterior displacement Coracoacromial ligament: controls

anterior and posterior translation

of the lateral clavicle

Acromioclavicular ligament:provides stability across the joint;

restrains posterior translation and

displacement of the clavicle


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Glenohumeral joint

Capsular ligaments: joinsthe glenohumeral jointcapsule anteriorly,

inferiorly, and posteriorly

Coracohumeral ligament:provides stability

superiorly, preventingsuperior translation


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Muscles of the Rotator Cuff

Supraspinatus: abducts

the humeral head and

acts as a humeral head

depressor

Infraspinatus: externally

rotates and horizontally

extends the humerus

Teres minor: externally

rotates and extends the

humerus

Subscapularis: internally

rotates the humerus


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Physical Examination

Look

From the front, side, & above: Asymmetry, scars,

deltoid wasting, SCJ or ACJ deformity, swelling of

the joint.

From behind : Look and feel for rotator cuff

wasting, scapula shape and situation e.g. winging,

Sprengel shoulder etc.


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Physical Examination (2)

Feel :

Skin temperature, tenderness, crepitus

SCJ to the ACJ and acromion

Greater and lesser tuberosity, feel for rotator cuff

defects

Glenohumeral joint: anterior and posterior

aspects Biceps tendon/bicipital groove

Spine of scapula


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Move : Always examine the cervical spine first

Active & passive movement, power

Move both arms at the same time. Active then

passive ROM.

Quick screening test: "Arms above the head and

behind the back "

Flexion: 0-180 Abduction: 0-180 check for painful arc and

watch the scapulohumeral rhythm


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If restricted then repeat with the scapula fixed to

check for the amount of glenohumeral

movement

Internal rotation: T4

External rotation: 70

Feel for crepitation during passive motion


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Subacromial Impingement

Hawkin's test:

Shoulder flexed 90,

elbow flexed 90;

Internal rotationpain.


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Subacromial Impingement

Empty Can Test

(Copeland):Passive abduction in internal

rotation (in the scapula plane)

painful; pain eliminated with

passive abduction in external

rotation.


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AC Joint

Scarf test:Forced cross body

adduction in 90flexion,

pain at the extreme

of motion overThe ACJ is indicative of

ACJ pathology


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Supraspinatus/anterosuperior cuff

Jobe's test

(emptycantest):

Arm abducted to

20, in the plane ofthe scapula, thumb

pointing down.

Resisted abduction

with arms by side.


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Infraspinatus+teres minor/Posterior cuff

Patte's test:

90 flexion, flexed

elbow and resisted

external rotation

Hornblower's sign (Emery):Similar to Patte's test.

Inability to ER & Abduct from

hand in front of mouth (against

gravity)


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Subscapularis/Anteroinferior cuff

Gerber's lift off test:Push examiner's hand

away from 'hand behind

back position.

LaFosse Belly-Press test:In the standing position the

patient puts a hand on the

stomach and pushes as hard as

possible. Elbow will drop

backwards if positive


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Biceps

Speeds Test:Elbow is extended, forearm

supinated and the humerus

elevated to 60. The examiner

resists humeral forward

flexion.

Yorgason Test:the patient's elbow is flexed to 90 degrees

with the thumb up. The examiner grasps

the wrist, resisting attempts by the

patient to actively supinate the arm and

flex the elbow


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STABILITY TESTS

Apprehension TestPatient supine or seated and the shoulder in a neutral

position at 90 degrees of abduction. Applies slight anterior

pressure to the humerus and externally rotates the arm. Pain

or the feeling of impending subluxation or dislocationindicates anterior glenohumeral instability.


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STABILITY TESTS

Relocation Test (Jobe)Performed immediately after a positive result on the anterior

apprehension test. With the patient supine, the examiner applies

posterior force on the proximal humerus while externally rotating the

patient's arm. A decrease in pain or apprehension suggests anteriorglenohumeral instability.


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STABILITY TESTS

Posterior Apprehension Test (Jerk Test)

With the patient supine or sitting, the examiner pushes

posteriorly on the humeral head with the patient's arm in 90

degrees of abduction and the elbow in 90 degrees of flexion.

A positive test is indicated by a sudden jerk as the humeral

head slides off the back of the glenoid.

examination of the shoulder

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