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Examination of The Shoulder
Examination of The Shoulder
SHOULDER
OUTLINE
INTRODUCTION
ANATOMY
EXAMINATION
DIFFERENTIAL DIAGNOSIS OF SHOULDER
PAIN
CONCLUSION
Introduction
Anatomy
Examination
LOOK
Skin
ForScars
Swellings
Erythema
Sinuses (axilla)
Soft tissue
Bone
Feel
Be careful not to elicit inappropriate
tenderness & cause discomfort....be
gentle!
Referred or LOCAL?
EPOULETTE SIGN
Test to diff referred from local pain. A test of
pain localisation.
Localisation in the
shoulder
Feel
Soft tissue
FEEL
Trapezius Ms for tenderness- common in
referred pain from neck.
For tenderness along the margin of
acromion suggest problem with the cuffs
Bone
MOVE
1.
2.
3.
4.
Abduction
Observe for hesitancy and break in
smooth rhythm and note the point at
which pain is detected
Place your hand on the shoulder to detect
crepitations originating from subacromial
region due to degenerative tendinitis of
rotator cuff.
Adduction
Instruct the patient to bring his hand
across the chest as in reaching for the
opposite shoulder
Normal value is 45 deg.
Flexion and extension
Ask the patient to lift both arms forward
and then backwards.
Normal value is 180 of flexion and 45 of
extension
External rotation
With the elbow maintained by the side
and forearm pointing straigthforward,
instruct the patient to move the forearm
away from the body.External rotation is
about 45
Internal Rotation
In the position above, instuct the patient
to bring the fore arm towards the
abdomen.Internal rotation is about 55
Rotation
Flex the patients elbow with the forearm
supported by the examiner, maintain the
elbow by the side of the body,internally and
externally rotate the shoulder using the
forearm as a lever.
Adduction
Anchor the patient by placing the hand
across the top of the shoulder,adduct the
upper arm across the front of the body,
noting the range of motion.
Power
Deltoid:
Test abduction against resistance. Axillary
nerve palsy can result in decreased
deltoid power.There is also loss of
sensation in the regimental badge area of
the shoulder.
Serratus anterior: Pushing against the
wall may demonstrate winging of the
scapular secondary to palsy of the long
thoracic nerve of Bell.
stability
Thumb down
Apprehension test
Sulcus test
Special Tests
Conclusion
THANKS.....