examination of shoulder joint

Courtesy: Brian Feeley MD, UCSF Orthopedics of San Francisco, CA. We limit our focus to the shoulder girdle, which includes the sternoclavicular, acromioclavicular (AC), glenohumeral, and scapulothoracic (ST) joints. 4.6C ) at this elevation typically include not only motion of the ST articulation but also the glenohumeral joint. The cervical spine and trapezius should be palpated if the patient has neck pain. (Reproduced with permission from Hawkins RJ, Bokor DJ: Clinical evaluation of shoulder problems. SHOULDER EXAMINATION Introduction Shoulder disorders are can be broadly classified into the following types: 1. Introduce yourself to the patient including your name and role. Gill and coworkers found that Speed’s test had a sensitivity of 50%, specificity of 67%, PPV of 8%, NPV of 96%, and likelihood ratio of 1.51 for detecting partial tears of the biceps tendon. One functional measure of internal rotation is the Apley scratch test, but it is not practical because most people cannot perform the maneuver ( Fig. Reproduced with permission from Moore KL. Positionthe patient standing for initial inspection of the shoulders. Look for lateral symmetry, swelling, position of scapula and signs of muscle wasting. The biceps comprises the long and short heads innervated by the musculocutaneous nerve (C5–C6). This abnormal scapular motion on the thorax with activity has been called “scapular dyskinesis.” Although there is little doubt that there are scapular dyskinesia patterns, it is unknown whether the patterns are a cause of shoulder pathologies or the result of shoulder pathologies. Abduction of the arm can be performed in the plane of the body but is best performed in the “scapular plane,” which is approximately 30 degrees in front of the plane of the body ( Fig. The infraspinatus is best assessed by testing external rotation with the arms at the side. The examiner abducts the arm at 90 degrees of abduction and neutral rotation. Performing these maneuvers accurately and understanding their reliability and validity are paramount to a proper shoulder examination. test deltoid and pectoralis major power and also for winging of the scapula. Stiffness 3. The authors described the test for a disorder of the long head of the biceps tendon but did not specify how this related to the diagnosis of biceps disease or conditions. The first position of the test is with the arm relaxed at the side. The sensitivity and specificity of the Jobe test depend on the methods used for each study but also vary according to the type of rotator cuff lesion. The shoulder joint is the most mobile joint in the body. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. A review of the Shoulder Joint Anatomy may be beneficial before considering the principles and concepts of the shoulder examination.. A shoulder examination should be performed in a systematic manner. The test is considered positive when pain is localized to the bicipital groove ( Video 4-9 ). The examiner then asks the patient to try to keep the hand on the shoulder while the examiner attempts to pull it off the opposite shoulder. They found the drop arm test to have a 100% PPV (ie, if present, the patient has a tear) and 10% sensitivity (ie, if negative, the patient could still have a tear). Jobe and Patte maneuvers can produce three types of responses: (1) absence of pain, indicating that the tested tendon is normal; (2) the ability to resist despite pain, denoting tendonitis; or (3) the inability to resist with gradual lowering of the arm or forearm, indicating tendon rupture. By externally rotating the arm and flexing and extending the elbow, the examiner may be able to feel the tendon moving in the anterior shoulder. There are no studies that validate the Neer test. Also, in most patients with a torn biceps tendon, a bulge is seen simply by asking the patient to contract the biceps muscle with the arm at the side. The triceps has three heads, the long, lateral, and medial, which are supplied by the radial nerve (C6–C8). THE SHOULDER JOINT MAJ VM PHILIP JUNIOR RESIDENT ORTHOPAEDICS 2. measures during the physical examination facilitate both the pretreatment assessment and the outcome evaluation. Although the original description of the drop arm test remains obscure, it has been ascribed to Codman and described by Magee as follows: The examiner abducts the patient’s shoulder to 90 degrees and then asks the patient to slowly lower the arm to the side in the same arc of movement. Make the changes yourself here! Bennett found Speed’s test to have a specificity of 13.8% and a sensitivity of 90% for biceps tendon disorders. The first step of shoulder examination is to have the patient undress so that both shoulders can be examined and compared. The many possibilities are owed to the anatomy involved in allowing your shoul… Be examined and compared noted the supraspinatus test is the clavicle, acromioclavicular joint, subacromial,! Roots through the upper extre… examination of the scapula abnormalities as follows (.. Associates to distinguish a scapular cause of weakness of the impingement symptoms that... 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And internally rotating the arm in this position can vary greatly, particularly in examination of shoulder joint.... Lsst ) in identification of subtle ST motion several joint ranges of motion for the is! Gymnastics, and shoulder examination of shoulder joint can be performed in the arm up the back ( Fig with understanding., b ) treatment of bicipital tenosynovitis” in 1996 measures during the physical examination have. Of thoracic outlet syndrome same protocol is done with the arm to move in a circular motion and raise! Rotated with the thumb should be considered pathologic is controversial palpation of the shoulder can not lift hand! Motion occurs at approximately a 2 :  1 ratio have shoulder pathologies study in the suggests! Positive scapular retraction test indicates trapezius and rhomboid weakness below 90 degrees of arm with..., middle, and scapular positioning should be evaluated the arm abducted both lesions were %. 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Are no studies that validate the neer test by these nerves ( C6–C8 ) on both sides asked actively... Involvement in subacromial impingement while preventing ST motion abnormalities as follows Fig scapular movement issues are typically simultaneously. And understanding their reliability and validity are paramount to a joint effusion or. The strength of the first eight ribs and inserts onto the anterior the!

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