Shoulder examination explained
A shoulder examination (or shoulder exam) is a portion of a physical examination used to identify potential pathology involving the shoulder. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting.
Elements of the shoulder exam
- Inspection
- Palpation of sternoclavicular joint, clavicle, acromioclavicular joint, subacromial bursa, bicipital tendon.
- Evaluation of passive and active range of motion: Neck range of motion should be assessed that may reveal a neck source of shoulder pain. The Apley scratch test specifically tests range of motion and in a normal exam, an individual should be able to reach C7 on external rotation, and T7 on internal rotation.
- Evaluation of distal pulses
- Strength testing: wrist extension tests the radial nerve, finger abduction tests the ulnar nerve, and thumb apposition tests the median nerve.
- Sensation testing
- Reflex testing: Triceps reflex tests C6-C8, biceps reflex tests C5 and C6, and brachioradialis reflex tests C5-C7.
- Provocative maneuvers
Provocative maneuvers specific to the shoulder examination
Tests for rotator cuff pathology
Tests for shoulder instability
Other tests
A meta-analysis in 2008 concluded that the diagnostic accuracy of individual tests in the shoulder examination was limited, specifically that the Hawkins–Kennedy test and the Speed test have no discriminatory ability to diagnose specific shoulder pathology, and that results of studies evaluating other tests were too statistically heterogeneous to make meaningful conclusions about their diagnostic accuracy.[3]
Examination of the shoulder can be complex because the shoulder can present with more than one pathology at a time.[4]
Notes and References
- The Painful Shoulder: Part I. Clinical Evaluation . THOMAS W. WOODWARD, M.D. . THOMAS M. BEST, M.D.. Am Fam Physician . May 15, 2000 . 61 . 10 . 3079–3088 . 10839557.
- Web site: Musculoskeletal Shoulder Examination: Shoulder Exam Maneuvers. University of Michigan. 5 August 2013.
- Br J Sports Med . February 2008 . 42 . 2 . 80–92; discussion 92 . Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. . Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, Cook C. . 17720798 . 10.1136/bjsm.2007.038406. free .
- Book: Edward G. McFarland. Tae Kyun Kim. Examination of the shoulder: the complete guide. 25 June 2011. 30 June 2006. Thieme. 978-3-13-141091-7.