The Shoulder Joint

1. The Shoulder Joint Examination

2. Subjective Examination • Age • Occupation and sports – overhead activities • Site – vague, C5 • Spread – large eg below elbow more severe • Onset – overuse, trauma, insidious • Duration – stages • Behaviour – constant, cannot lie on sh. ? • Symptoms – dizzyness, p + ns, cough and sneeze • PMSH – other joints, diabetes, heart probs, ops etc

3. Inspection • Posture – level of sh, csp, thsp, position of scap • Deformity • Colour • Wasting • Swelling • State at rest • Site of pain

4. Palpation • Heat and swelling - rare

5. Cervical Spine - Elimination • Extension with OP • Rotation with OP • Side Flexion with OP • Flexion

6. Active Movements • Active elevation with OP Pain, power, range, end feel and willingness • Abduction – painful arc?

7. Passive Movementspain, range and end feel • Lateral Rotation • Medial Rotation • Abduction – palp scapula to look for early movement • CAPSULAR? • LR>ABD>MR

8. Resisted Testspain and power • Abduction - supraspinatus • LR – infraspinatus and teres minor • MR - subscapularis • Elbow Flex - biceps • Elbow Ext - triceps • Add – pec maj, teres major and lat dorsi

9. Palpation

10. Differentiating Tests • In supine • Resisted abd • Resisted abd with distraction • Resisted LR • Resisted LR with distraction

11. Other tests • Scarf test – AC, lower fibres of subscap and bursae • Apprehension test – dislocation • Neural tension • Xray, scan, bloods