THE ORTHOPAEDIC EXAMINATION

BASIC RULES

LOOK

FEEL

MOVE

SPECIAL TESTS

SHOULDER EXAMINATION

KNOWLEDGE….

“The eye doesn’t see what the mind doesn’t

know”

Know common shoulder problems…

Young – shoulder instability

Old – shoulder impingement, rotator cuff tear

TAILOR YOUR EXAMINATION TO WHAT IS

SUSPECTED – P.E IS NOT A SET

ROUTINE

LOOK

Adequate exposure! (No shyness in exams!)

Always look from front, side and back

Always search for:

• Deformities

• Swellings

• Wasting

• Scars

• Sinus

AXILLA :

ALSO PART

OF

SHOULDER!

FEEL

Do it in a sequence

SC joint → clavicle → AC joint → acromion

→ scapula spine

Ant and post glenohumeral joint line

Axilla

Also feel for warmth

MOVE

POINTS TO REMEMBER

Shoulder has 6 axis of movement

The normal anatomy of glenohumeral joint is

facing anteriorly by 15-20 degrees

ABDUCTION / ADDUCTION

Normal range: 0 – 160/180 degrees

Supraspinatus → deltoid → scapula muscles (trapezius / serratus anterior)

Painful arc

Scapulohumeral rhythm

FLEXION / EXTENSION

Normal range:

Flexion: 0 – 180

Extension: 0 – 40

Always remember the plane of

scapulohumeral joint!

EXTERNAL / INTERNAL ROTATION

Normal both are 0 – 90 degrees

Best to do with shoulder abducted – Why?

But beware of dislocatable shoulder!

SPECIAL TESTS

AIM OF TESTS

1) To detect impingement

AIM OF TESTS

2) To detect rotator cuff tear (specific muscles)

AIM OF TESTS

3) To detect shoulder instability

HOW TO DO

For impingement – by manually causing

impingement between humerus and

acromion

Neer’s impingement sign Hawkin’s test

HOW TO DO

For rotator cuff tear – motions and power of

each muscle must be tested

Jobe’s test -

Supraspinatus

External rotation test –

Infraspinatus / Teres

minor

HOW TO DO

Gerber’s lift off test

Tests for

Subscapularis

Napoleon’s test

HOW TO DO

For instability – to demonstrate the instability

Sulcus signShoulder apprehension test

MUST ENSURE THE SHOULDER IS NOT

DISLOCATED DURING EXAMINATION!!!

POINTS TO PONDER

P.E must be done with knowledge

It is NOT a set routine

Must be able to spot diagnosis even before

starting P.E

Your P.E is to prove the diagnosis by

searching for relevant positives

And to rule out other diagnosis by searching

for relevant negatives

THANK YOU