2. Chief complaints:
Pain
Swelling
Deformity
Stiffness
Instability
Weakness
Loss of function
2Shoulder examination/ Sunil Baniya
3. 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
3Shoulder examination/ Sunil Baniya
4. Axillary area
Any sinus, scars, swelling
Arm position
Small muscles of hand
Side
Wasting of supraspinatus & infraspinatus
Winging of scapula
Swelling, sinus, scars
Shoulder examination/ Sunil Baniya 4
Fig : winged scapula
5. 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
5Shoulder examination/ Sunil Baniya
6. - 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
6Shoulder examination/ Sunil Baniya
7. 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
7Shoulder examination/ Sunil Baniya
8. - 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
8Shoulder examination/ Sunil Baniya
9. 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
9Shoulder examination/ Sunil Baniya
10. 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
10Shoulder examination/ Sunil Baniya
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
11. 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 =
infraspinatous tendon impingement
Shoulder examination/ Sunil Baniya 11
Fig : Neer's impingement sign
12. 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
12Shoulder examination/ Sunil Baniya
Fig : Hawkin's test
13. 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
Shoulder examination/ Sunil Baniya 13
14. 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
14Shoulder examination/ Sunil Baniya
Fig : Drop arm test
15. 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
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)
Shoulder examination/ Sunil Baniya 15
Fig : Gerber's lift-off test
16. Apprehension test:
Sitting upright position
Abduct at 90°, forwardly flex, externally rotate, then try
to push shoulder forward extending at the elbow
Pain
See patient’s face for apprehension
16Shoulder examination/ Sunil Baniya
Fig : Apprehension test for anterior subluxation or dislocation.
Abduct, externally rotate and extend the patient’s shoulder
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.
17. Jobe’s Relocation test:
Patient supine
Arm ½ part at the edge of couch
Externally rotate the forearm
Pain & apprehension appear first
Then press down on arm => should relieve pain or apprehension
Finding: Again pain occurs after release of downward pressure =>
anterior instability
17Shoulder examination/ Sunil Baniya
Fig : Jobe's relocation test
18. Sulcus test:
For inferior capsular laxity or instability
Patient sitting arm by side
Relaxed arm
Elbow flexed at 90°
Give downward axial force along the humerus by holding elbow
Another hand provide grip between acromian, anterior & posterior
18Shoulder examination/ Sunil Baniya
Fig : Sulcus sign
19. 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
Shoulder examination/ Sunil Baniya 19
20. 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)
20Shoulder examination/ Sunil Baniya