ASCM Clinical SkillsASCM Clinical Skills

ShoulderShoulder

LOOKLOOK

InspectionInspection Swelling, bony prominenceSwelling, bony prominence Bruising / lacerations Bruising / lacerations Position of armPosition of arm AsymmetryAsymmetry AtrophyAtrophy Surgical scarsSurgical scars

FEELFEEL

PalpationPalpation

• Expose both shoulders

• Palpate bony prominences

• Soft tissue palpation, least tender areas first

• Compare to contralateral side

AC Joint

MOVEMOVE

ACTIVEACTIVEPASSIVEPASSIVE

ABNORMALABNORMAL

Compare both shouldersCompare both shoulders

Range of MotionRange of Motion

Forward Flexion:

180°

Range of MotionRange of Motion

Abduction: 180°

Range of MotionRange of Motion

External Rotation:

60-80°

Range of MotionRange of Motion

Internal Rotation:

T7

Range of MotionRange of Motion

Internal Rotation at

90° Forward Flexion: 90°

Rotator Cuff InjuryRotator Cuff Injury

• Tendonopathy or tear• Partial or complete• Acute or chronic

Rotator Cuff InjuryRotator Cuff Injury

Jobe Test:SupraspinatusMiddle deltoid

Rotator Cuff InjuryRotator Cuff Injury

External Rotation:

Teres minorInfraspinatus

Rotator Cuff InjuryRotator Cuff Injury

Internal Rotation:

SubscapularisPectoralis

majorLatissimus

dorsi

Rotator Cuff InjuryRotator Cuff Injury Drop Arm TestDrop Arm Test: :

Unable to resist Unable to resist pressure at pressure at 90°90° abductionabduction

Painful ArcPainful Arc: : Between Between 45 °45 ° and and 120°120° abduction abduction

ImpingementImpingement

• Usually subacromial space• Irritation between AC joint, RC

tendons and bursae

ImpingementImpingement

Neer’s Test

ImpingementImpingement

Hawkin’s Test

Biceps tendonitis/tearBiceps tendonitis/tear

• Usually long head• Related to overuse/activity• Anterior shoulder pain• Acute or chronic• Weakness with resisted

flexion/supination

Biceps Tendon

Biceps tendonitisBiceps tendonitis

Yergason’s Test

Biceps tendonitisBiceps tendonitis

Speed’s Test

AC Joint arthritisAC Joint arthritis

Crossed Adduction Test

GH Joint LaxityGH Joint Laxity

•Apprehension Test

•Relocation

GH Joint LaxityGH Joint Laxity

Sulcus Sign

GH Joint LaxityGH Joint Laxity

Load and Shift Test

Referred PainReferred Pain

NeckNeck ElbowElbow HeartHeart DiaphragmaticDiaphragmatic Pan coastPan coast

Neurological ExaminationNeurological Examination

Radial nerve – Thumbs upRadial nerve – Thumbs up Median nerve – Thumb to hypothenar Median nerve – Thumb to hypothenar

eminenceeminence Ulnar nerve – Abduct VUlnar nerve – Abduct V Axillary nerve - DeltoidAxillary nerve - Deltoid