Shoulder Examination

Prepared by:
Sunil Baniya
Student, NAIHS-COM
sanobharayang, ktm

Shoulder examination/ Sunil Baniya 1

Chief complaints:

 Pain

 Swelling

 Deformity

 Stiffness

 Instability

 Weakness

 Loss of function

Shoulder examination/ Sunil Baniya 2

 Examination is done either in sitting or standing position with sufficient
exposure.

1. Look :

Front
 Head, neck alignment

 Shoulder symmetry

 Prominent AC joint/ swelling

 Fullness of supra-clavicular area

 Wasting of deltoid

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 Axillary area

 Any sinus, scars, swelling

 Arm position

 Small muscles of hand

Side
 Wasting of supraspinatus & infraspinatus

 Winging of scapula

 Swelling, sinus, scars

Fig : winged scapula

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Back
 Wasting of deltoid

 Drooping of shoulder

2. Feel :
a. Temperature:
- Periphery to centre or proximal to distal

b. Tenderness:

 For tenderness palpate over

- Sterno-clavicular joint

- Along clavicle

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- Acromio-clavicular joint

- Spine of scapula

- Borders

- Shoulder joint line

- Coracoid process

- Biceps tendon in bicipital groove (arm flexion, elbow flexion at 90°, then
internally/ externally rotate & palpate)

- In axilla palpate humeral head

- Fullness of inferior recess in shoulder effusion

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3. Movement:
 Active movement (passive movement need not to be done)

- Flexion : 0- 160/ 180°

- Extension : 0- 180°

- Adduction : 0-15° (cross arm)

- Abduction : 0-180°

*First 15° = supraspinatus

*15-90° = deltoid

*>90° = serratous anterior

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 - Internal rotation : 15° (touches inferior border of opposite scapula or thumb
touches upto T5 spine)

- External rotation : 60°

(Rotational movement at various position)

4. Special Tests:
a. Impingement tests:

i) Painful arc test

ii) Neer’s impingement test

iii) Hawkin’s / Hawkin Kennedy test

iv) Jobe’s test/ Empty can test

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b. For Rotator cuff tendon tear:

i) Drop arm test

ii) Lift off test/ Gerber’s test

c. For Rotator cuff instability:

i) Apprehension test

ii) Jobe’s relocation test

iii) Sulcus test

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 Painful arc test:
 for painful arc syndrome

 shoulder pain occurring at 60-120° of arc

 Described when arm is abducted from the side

to fully raised position

 +ve in supraspinatus tendinitis

During active abduction, the scapulohumeral rhythm is disturbed on the right and
the patient starts to experience pain at about 60 degrees (a). As the arm passes
beyond 120 degrees (b) the pain eases and the patient is able to abduct and elevate
up to the full 180 degrees

Shoulder examination/ Sunil Baniya 10

Neer’s Impingement test:
 Patient standing or sitting

 Hand prone

 Extending at elbow, passively elevate the arm

>90° or above the shoulder

 Other hand of examiner fixes the shoulder

 +ve pain at anterolateral aspect of shoulder = Fig : Neer's impingement sign

infraspinatous tendon impingement

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Hawkin’s test/ Hawkin Kennedy test:

 Fixing scapula/ shoulder

 Abduction of shoulder at 90°, forward flexion of

elbow

 Internal rotation by examiner by grasping just

below elbow

 Finding : pain at shoulder => Subacromial

impingement Fig : Hawkin's test

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Jobe’s test/ Empty Can test:
 Patient standing

 Arm forwardly flexed at the level of shoulder

 Fully pronate arm into empty can position

 Ask patient to resist downward force applied

 Finding : pain or weakness => Supraspinatus tendon lesion

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Drop arm test:

 Passively forward flex the arm after shoulder

stabilization by other hand

 Bring 90° abduction state

 Let the patient to hold his hand in that position

 Arm drops

 Finding: complete rotator cuff tear Fig : Drop arm test

Shoulder examination/ Sunil Baniya 14

Lift off test/ Gerber’s test:

 Patient is asked to stand

 Place his/her one arm behind his/her back with the dorsum of the
hand resting against the mid-lumbar spine

 The examiner then lifts the patient’s hand off the back

 And the patient is told to hold it there

Fig : Gerber's lift-off test

 Finding: Inability to do so=>weakness => rupture of Sub-scapularis

tendon
(Drawback: needs full internal rotation, can not be done when restricted or pain on
doing so)
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Apprehension test:

 Sitting upright position

 Abduct at 90°, forwardly flex, externally rotate, then try

to push shoulder forward extending at the elbow

 Pain
Fig : Apprehension test for anterior subluxation or dislocation.
Abduct, externally rotate and extend the patient’s shoulder
 See patient’s face for apprehension while pushing on the head of the humerus. If the patient feels
that the joint is about to dislocate, she will forcibly resist the
manoeuvre.

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Jobe’s Relocation test:

 Patient supine

 Arm ½ part at the edge of couch

 Externally rotate the forearm

 Pain & apprehension appear first

Fig : Jobe's relocation test

 Then press down on arm => should relieve pain or apprehension

 Finding: Again pain occurs after release of downward pressure =>

anterior instability

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Sulcus test:

 For inferior capsular laxity or instability

 Patient sitting arm by side

 Relaxed arm

 Elbow flexed at 90°

Fig : Sulcus sign
 Give downward axial force along the humerus by holding elbow

 Another hand provide grip between acromian, anterior & posterior

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OR,

 Arm forward flexion at 90°

 Elbow bent at 90° & internally rotated

 Finding: sulcus appear between acromial arch and humeral head => test the degree
of inferior capsular laxity

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5. Measurement:
 Take only either of two bony points as reference for girth/bulk of humerus i.e;
acromian or lateral epicondyle of humerus

6. Axillary lymph nodes

7. Cervical spines

8. Distal Neurovascular Status (DNVS)

 Radial pulse

 Sensory examination (autonomous zone of radial, median & ulnar nerve)

 Motor examination (5 groups = C5, C6, C7, C8, T1)

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 C5 = elbow flexion

 C6 = wrist extension

 C7= wrist flexion, finger extension

 C8 = finger flexion

 T1 = finger abduction

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Thank You

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