PHYSICAL EXAMINATION OF

THE SHOULDER
HK/RM/ST/HB/AT
 Shoulder Joints
Sterno-clavicular joint
Acromioclavicular joint
Glenohumeral joint
Scapulothoracic joint
 Glenohumeral Joint Stabilisers

Glenoid
Glenoid Labrum
Negative intra-articular pressure
Gelnohumeral capsular ligaments
Rotator Cuff and scapular musculature
 Glenohumeral Ligaments
SGHL
MGHL
IGHL Complex
Anterior band
Posterior band
Axillary pouch
 Shoulder Examination
Inspection
Skin, scar, symmetry, swelling, arthropy, hypertrophy,
scapular winging.
Palpation
All bony prominance around shoulder gridle (AC joint)
Muscle and soft tissue include (deltoid, rotator cuff
muscle, trapezius, biceps tendon in groove)
Range of motion
Compare active and passive motion, both sides
Inspection
Topical scan :
Skin
Scars
Symmetry
Swelling
Atrophy
Hypertrophy
Scapular winging
Winging scapulae
Feel / palpation
 Move

Shoulder internal rotation and

Apley Scratch test for shoulder internal adduction Apley Scratch test for external rotation
rotation and abduction and abduction
 Neer Impingement Sign
is tested by having the patient place his
hand on the unaffected shoulder and
gradually forward flexing the shoulder;
- impingement sign is elicited w/ pt
seated and the examiner standing;
- scapular rotation is prevented w/ one
hand while other hand raises arm in forced
foward elevation
causing greater tuberosity to
impinge against the acromion;
- raise the arm somewhere between
flexion and abduction;
- this maneuver produces pain in pts w/
impingement lesions of all stages (as well
as partial frozen shoulder, instability,
arthritis ect.)
- if this motion is painful at 90 degrees of
forward flexion it is a positive sign for
impingement (primary impingement sign);
- pain during abduction of the arm to
80 deg and internal rotation is a secondary
impingement sign;
Apprehension Test/Relocation Test
 Sulcus Test
With the patient's arm in a
neutral position, the examiner
pulls downward on the elbow
or wrist while observing the
shoulder area for a sulcus or
depression lateral or inferior
to the acromion. The
presence of a depression
indicates inferior translation
of the humerus and suggests
inferior glenohumeral
instability
 Cross Arm Test
Cross-arm test for
acromioclavicular
joint disorder. The
patient elevates the
affected arm to 90
degrees, then
actively adducts it
 Yergason test
Yergason test for biceps
tendon instability or
tendonitis. The patient's
elbow is flexed to 90
degrees, and the
examiner resists the
patient's active
attempts to supinate
the arm and flex the
elbow.
 Speeds Maneuver
Forward flex the
shoulder against
resistance while
maintaining the
elbow in extension
and the forearm in
supination. Pain or
tenderness in the
bicipital groove in
dicates bicipital
tendinitis.
 A 52-year-old woman reports the sudden onset of intense
pain in the right shoulder. She denies any history of injury
or previous shoulder problems. At a 2-week follow-up
examination, she notes that the pain has decreased, but
she now has severe weakness of the external rotators and
abductors. Her cervical spine and remaining shoulder
examination are otherwise unremarkable. Radiographs of
the shoulder and neck are normal. What is the most likely
diagnosis?
1. Calcific tendinitis
2. Rotator cuff tendinosis
3. Bursitis
4. Brachial neuritis
5. Glenohumeral arthritis
 Answer is 4
Patients with brachial neuritis or Parsonage-Turner
syndrome usually report the sudden onset of intense
pain that subsides in 1 to 2 weeks, followed by
weakness for a period of up to 1 year in the muscle
that is supplied by the involved nerve. Calcific
tendinitis usually can be diagnosed radiographically,
with calcium deposits seen in the rotator cuff. Bursitis
and rotator cuff tendinosis usually are seen after an
increase in activity, and both decrease with rest and
medication. Glenohumeral arthritis is a slow,
progressive problem that results in a loss of range of
motion