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• Second level
• Third level Shoulder joint
• Fourth level

examination
• Fifth level
Shoulder examination

By the end of the session the student will be able to:

• Recognize different anatomical landmarks of the shoulder

• Recognize rotator cuff muscles and their actions
• Demonstrate types of shoulder movements
• Recall normal range of shoulder movements
• Palpate properly important anatomical landmarks of the shoulder
• Identify special tests of the muscles of shoulder region
Anatomical considerations
Ligaments of the shoulder joint
 Rotator Cuff Muscles

Keeping the head of humours firmly within the shallow socket of the
shoulder.
1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres minor
 Rotator cuff muscles

Rotator cuff Function:

To keep the humerus in the socket of the shoulder.

Rotator cuff injury:

• One of the most common causes of shoulder pain in middle aged persons.
• The rotator cuff tendons particularly the supraspinatus tendon, are susceptible to the compressive forces
of subacromial impingement

Impingement syndrome
• Describes symptoms and signs that result from compression of structures around the glenohumeral joint,
including the rotator cuff tendons and subacromial bursa.
 Range of motion

Forward flexion: normal range (0-165)

Backward extension: normal range (0-60)
Movements of the shoulder joint

Abduction: normal range (0-180)

Adduction: normal range (0-50)

Internal rotation in extension: normal range 70

External rotation in extension: normal range70

Internal rotation in abduction: normal range 70

External rotation in abduction: normal range 100
External Rotation in abduction (100)

Internal Rotation in abduction (70)

Shoulder joint examination

Inspection

Palpation

Movement
 inspection from the front

Inspection

• Front: inspect for:

• Swelling
• Scar
• Sinus
• Prominent sternoclavicular joint
• Prominent acromioclavicular
joint
• Deformity of clavicle
• Deltoid wasting
 inspection from the side

Inspection

• Side: inspect for:

• Swelling
• Scar
• Sinus
 inspection from the back

Inspection

• Behind: inspect for:

• Swelling
• Scar
• Sinus
• Shape and position
• of the scapula
 Inspection

• Above: inspect for

• Swelling of the shoulder

• Deformity of the clavicle

• Asymmetry of supraclavicular fossa

 Palpation
• Temperature.
• Humeral head and shaft via axilla
• Acromioclavicular joint for tenderness
• Below the acromion and abduct the arm (for tears and inflammation of the
shoulder cuff and subdeltoid bursa)
• The whole length of the clavicle
• Crepitus: put the fingers on ACJ and abduct the shoulder with the other hand
Palpation
Palpation
 Movement

• Flexion:
• Normal range (0-165)
• Ask the patient to swing the arm forwards, lift it above his head. View the patient
from the side.
• Extension:
• Normal range (0-60)
• Ask the patient to swing the arm directly backwards. View the patient from the side.
 Movement
• Abduction:
• Normal range (0-180)
• Ask the patient to abduct both arms, note for pain and ROM.
• N.B:
• pain in 70-120: impingement in acromion region
• Pain in 120-180: impingement in acromioclavicular joint or
coracoacromial ligament
• Adduction:
• Normal range (0-50)
• Place one hand one the shoulder, swing the arm flexed at the elbow across the chest
 Movement
Rotation screening:
• Internal rotation in extension: normal range 70
• Ask the patient to place his hand behind the opposite shoulder.
• External rotation in extension: normal range70
• Place the elbow in both sides, flex the arm to 90 with hands facing forwards, move
hands laterally
• Internal rotation in abduction: normal range 70
• Abduct the shoulder to 90, flex the elbow to 90, ask the patient to lower the forearm
from the horizontal plane
• External rotation in abduction: normal range 100
• Abduct the shoulder to 90, flex the elbow to 90, ask the patient to raise his hands
 Movement

• Shoulder elevation and depression

• Normal ranges are 37,8
 Cervical spines

Cervical spines should also be examined

 Special tests

Jobe test: (for supraspinatus)

The patient places both arms in 90°
abduction and 30° flexion in the frontal
plane, thumb pointed to the floor, elbows
should remain extended. The examiner
then pushes the patient's arms downwards
while asking the patient to resist pressure.
https://youtu.be/cD4H-4kxSNQ
Thank you