Shoulder

Shoulder:

Inspection

patient should be standing: look for muscle wasting, skin changes, scars & swellings

Palpation

start at sterno-clavicular joint (medial side of clavicle), move across clavicle to acromio-clavicular joint (prominence in this joint = dislocation or arthritis) then to scapula + palpate surrounding muscles for tenderness
assess joint temp
check axilla for effusion or lymphadenopathy

Movement

flexion: arms straight up in front (normal = 0-170 degrees)
extension: arms straight backwards (normal = 0-40 degrees)
abduct arms from their side straight up, scapular does not move for first 90 degrees, observe from behind (normal = 0-160 degrees), pain during the arc (between 70-120 degrees) suggests impingement syndrome.
external rotation: bend at elbow & turn arm outwards (normal = 0-70 degrees), will be reduced in frozen shoulder (=connective tissue surrounding shoulder becomes inflamed = adhesions = restricted movement + pain)
internal rotation: bend at elbow and turn arm inwards (normal = 0-90 degrees)
can also ask patient to: put hands behind head & elbows back (tests internal rotation & abduction of shoulder joint) or to get their thumb as high up their back as possible (also tests internal rotation of shoulder joint)
NB. if patient cannot perform movement actively, you do it for them passively until you reach a point of pain

Neuro/special tests

sensation: the most common neurological deficit is axillary nerve palsy following a dislocation, therefore test sensation over the deltoid muscle =‘badge patch’ sign
motor: check for contraction of deltoid with abduction against resistance
apprehension test: gently externally rotate the shoulder whilst in the 90 degrees abduction & 90 degrees elbow flexion position, patient will becoming apprehensive = a sign of anterior instability, usually due to a previous anterior dislocation
copeland’s test: abduct shoulder against resistance with arm in neutral then internally rotated, increased pain when internally rotated suggests impingement syndrome (=wear & tear of the shoulder’s rotators cuff tendon)

Function