SHOULDER

EXAMINATION
 the scapula is offset 30 degrees from the
frontal plane -- this is called the scapular
plane
Acromioclavicular joint

 Coracoacromial ligament: controls

anterior and posterior translation of
the lateral clavicle

 Coracoclavicular ligament:
controls vertical stability; restrains
superior and anterior displacement

 Acromioclavicular ligament:
provides stability across the joint;
restrains posterior translation and
displacement of the clavicle
Glenohumeral joint

 Capsular ligaments: joins the

glenohumeral joint capsule
anteriorly, inferiorly, and
posteriorly

 Coracohumeral ligament:
provides stability superiorly,
preventing superior translation
Rotator Cuff
 Supraspinatus: abducts the
humeral head and acts as a humeral
head depressor

 Infraspinatus: externally rotates

and horizontally extends the
humerus

 Subscapularis: internally rotates

the humerus

 Teres minor: externally rotates and

extends the humerus
Subscapularis
Conditions
 Tumors/swellings
 Nonunions
 Instability
 Subacromial impingement
 Rotator cuff rupture
 SLAP Lesions
History
 Pain/instabilty/both
 Decreased ROM
 Dominant hand
 Occupation
 Trauma
 Childhood history
General examination
 Prominent veins
 Neck viens/swellings
 Chest movements
 Fingers – trophic changes
 General condition

CHEST EXAMINATION
Shoulder examination
 LOOK
 TOUCH
 MOVE
 MEASURE
Inspection
 Attitude
 Front
 Side
 Back
Inspection
 Front
 Chest wall
 Pect major
 Clavicle/recess
 AC joint alignment
 Deltoid contour
 Any other swellings
 Side
 Deltoid
 AC joint
 Wasting of cuff muscles
 Swellings
 head of humerus
 Scapula

 Ant chest wall

 Back
 Swellings
 Muscles = wasting
 Scapula alignment
 AC joint
 Deltoid
 Interscapualar region
 Above
 Shoulder alignment
 Spine
 swellings
Palpation
 Temperature
 Tenderness
 Swellings
 Bony points
 Clavicle
 Acromion
 Humeral head
 Coracoid
 AC joint
 Scapula
Movements
 Flexion
 Extension
 Internal rotation
 External rotation
abduction
Measurements
 Arm length
 Arm span:height
Special tests
Apley Patient touches superior and inferior Loss of range of motion:
scratch test aspects of opposite scapula rotator cuff problem
Neer's sign Arm in full flexion Subacromial
impingement
Hawkins' Forward flexion of the shoulder to 90 Supraspinatus tendon
test degrees and internal rotation impingement
Drop-arm Arm lowered slowly to waist Rotator cuff tear
test

Cross-arm Forward elevation to 90 degrees and Acromioclavicular joint

test active adduction arthritis
Spurling's Spine extended with head rotated to Cervical nerve root
test affected shoulder while axially loaded disorder
Apprehensi Anterior pressure on the humerus with Anterior glenohumeral
on test external rotation instability
Relocation Posterior force on humerus while Anterior glenohumeral
test externally rotating the arm instability

Sulcus sign Pulling downward on elbow or wrist Inferior glenohumeral

instability

Yergason Elbow flexed to 90 degrees with forearm Biceps tendon instability

test pronated or tendonitis

Speed's Elbow flexed 20 to 30 degrees and Biceps tendon instability

maneuver forearm supinated or tendonitis

"Clunk" sign Rotation of loaded shoulder from Labral disorder

extension to forward flexion
Special Tests - Instability
 Sulcus sign
Special Tests – Instability
Gerber-Ganz Anterior Drawer Test &
Jerk test
Special Tests - Instability
 Anterior apprehension sign
Special Tests - Instability
 Relocation test

Apprehension
Special Tests - Impingement
 Neers sign
 Hawkins sign
 Jobes sign
 Special Tests - Impingement
 Neers sign
Special Tests - Impingement
 Hawkins test
Special Tests - Impingement
 Jobes test
Special Tests - Rotator Cuff
 External rotation lag sign (ERLS)
 Hornblowers sign
 Infraspinatus / teres minor
 Internal rotation lag sign (IRLS)
 Liftoff test
 Subscapularis
 Zaslavs internal impingement test
Special Tests - Rotator Cuff
 External rotation lag sign (ERLS)
 Infraspinatus / teres minor
Special Tests - Rotator Cuff
 Internal rotation lag sign (IRLS)
 Liftoff test Subscapularis
Special Tests - Rotator Cuff
 Belly Press test
Special Tests - Rotator Cuff
 Zaslavs internal impingement test
Special Tests - Biceps
 Speeds test
 Yergasons test
Special Tests - Biceps
 Speeds test
Special Tests - Biceps
 Yergasons tests
Special Tests – SLAP Lesions
 O’Briens Test
 Compression / rotation test
 Pain Provocation test
Special Tests – SLAP Lesions
 O’Briens Test
Special Tests – SLAP Lesions
 Compression / rotation test
Special Tests – SLAP Lesions
 Crank test
Special Tests – SLAP Lesions
 Kiblers anterior slide test
Ac joint – cross arm test
 Point tenderness over AC joint
Scarf test
Finally
 Neurological examination
 Hand functions
 Pulses
 Other shoulder
 Same elbow

SPINE