Examination of the Shoulder

Liem Arinuryanto Lios

Edited by Valentine Ongko

Anatomy

Anterior View

Anatomy

Posterior View

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

Glenohumeral joint
Capsular ligaments: joins the glenohumeral joint capsule anteriorly, inferiorly, and posteriorly Coracohumeral ligament: provides stability superiorly, preventing superior translation

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

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.

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

Physical Examination (3)

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

Physical Examination (4)

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

Subacromial Impingement
Hawkin's test:
Shoulder flexed 90, elbow flexed 90;

Internal rotation pain.

Subacromial Impingement
Empty Can Test (Copeland):
Passive abduction in internal rotation (in the scapula plane) painful; pain eliminated with passive abduction in external rotation.

AC Joint
Scarf test:
Forced cross body adduction in 90flexion, pain at the extreme of motion over The ACJ is indicative of ACJ pathology

Supraspinatus/anterosuperior cuff
Jobe's test
(empty can test): Arm abducted to 20, in the plane of the scapula, thumb pointing down. Resisted abduction with arms by side.

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)

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

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

STABILITY TESTS
Apprehension Test
Patient 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 dislocation indicates anterior glenohumeral instability.

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 anterior glenohumeral instability.

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.