Shoulder examination. P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College
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1 Shoulder examination P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College Manipal University, Manipal
2 Common symptoms Tingling Numbness Pain Loss of movements Weakness
3 Approach Joint Arthritis Inflamed Bursa Capsule Tight- Frozen shoulder Ruptureddislocation Inflamed/ rupture Tendon, rotator cuff
4 History Age Age < 40 Age >40 Instability Cuff tears Adhesive capsulits Rotator cuff tendinopathy Calcific tendinitis Arthritis (GH & ACJ)
5 History Duration* Acute: Calcific tendinitis Infections Trauma Chronic: Rotator cuff tear / Impingement Frozen shoulder Arthritis
6 History Instability Cuff tears SLAP Trauma (mechanism)*
7 History Inability to perform certain activities Can t throw: SLAP/ Labral lesion Can t lift: RC tear/ Frozen shoulder
8 History Sports participation Instability & cuff overuse *Overhead sports: baseball, softball, tennis *Collision sports: hockey, football, rugby ACJ arthritis *weight lifter
9 History Pain* Pain at night; can t sleep on shoulder Rotator cuff tear / Impingement Frozen shoulder
10 History Pain* Pain with overhead activity Rotator cuff disease ACJ arthritis Scapular dyskinesia
11 History Pain* Pain localized to top of shoulder** ACJ Arthritis ACJ separation
12 History Pain radiation Pain over deltoid and lateral arm Subacromial bursitis Adhesive capsulitis GH arthritis
13 History Pain* Pain &/ tingling sensation; aggravated by lifting arm or weakness IVDP; C. spine
14 History Weakness in lifting arm* Rotator cuff tear Brachial plexus injury
15 History Passive loss of movement* GH arthritis Adhesive capsulitis
16 History Systemic illness Diabetes mellitus Thyroid disorder Epilepsy Heart disease
17 History Pain Stiffness Weakness Pathoanatomy Frozen shoulder Cuff tear Biomechanics Arthritis Nerve injury
18 Examination Look Feel Move Special test *Undress upper half
19 Examination Attitude Muscle wasting Deformities Inspection (front)
20 Examination Inspection
21 Examination Muscle wasting Deformities Scapula Spine Inspection (back)
22 Examination
23 Examination
24 Examination Inspection (scapula)
25 Examination Inspection (scapular dyskinesia)
26 Palpation Bony prominences: Tenderness AC joint Bicipital groove Coracoid process Joint line Tuberosities Supraspinous fossa Ligament laxity***
27 Movements Range- active & passive Painless or painful GH/scapulothoracic
28 Movements Range- active & passive Movements Active Passive Conclusion + + Normal / Altered rhythm / referred pain - + Not stiff / cuff tears - - Stiff, arthritic
29 Special tests for.. Acromioclavicular joint Impingement tests Rotator cuff tears Labral lesions Bicipital tendon disease Stability Others..
30 Examination Associated condition Sensitivity Specificty Muscle wasting (Supra/infraspinatus) Acromio-clavicular tenderness Rotator cuff tear ACJ arthiritis / chronic sprain Resticted ROM Adhesive capsulitis Hawkins Impingement Impingement/ rotator cuff disorder Drop arm test Large rotator cuff tear Empty can supraspinatus RC involving supraspinatus Lift off subscapularis RC involving subscapularis External rotation Infraspinatus strength RC involving infraspinatus Cross body adduction ACJ arthritis Apprehension GH instability Relocation GH instability 81 92
31 ACJ
32 Impingement
33 Rotator cuff test Rotator cuff tear (SS) Empty & full can test Full can: Specific for Full thickness cuff tear Negative in tendinitis & Partial cuff tear
34 Rotator cuff test Rotator cuff tear (SS) Jobe s supraspinatus test Full can sign pain + strength
35 Rotator cuff test Rotator cuff tear (SS) Empty and full can test
36 Rotator cuff test Rotator cuff tear Infraspinatus & teres strength
37 Rotator cuff test Rotator cuff test Drop arm test (Codman s sign) for massive rotator cuff tears
38 Rotator cuff test Rotator cuff tear Gerber s subscapularis liftoff test
39 Rotator cuff tear Napoleon / belly press sign
40 Rotator cuff test Rotator cuff test External & internal rotations in 90 0 abduction Crepitus indicates hypertrophied subacromial bursa or rotator cuff tear
41 Bicipital tendon test Bicipital tendon test
42 Speed s SLAP and lesions O Brien test
43 Anterior stability test Apprehension test
44 Anterior stability test Sulcus sign
45 Compression neuropathy Supraspinatus and infraspinatus weakness presents as cuff tear However, - Neer s -ve - Hawkins -ve - other cuff test -ve
46 Compression neuropathy Serratus anterior: Winging (Up & in) Trapezius: Winging (Down & out)
47 Still no clues
48 Do examine Cervical spine Chest Thoracic outlet CVS & Abdomen
49 Cervical Do examine spine
50 Do Chest examine
51 Do Heart examine
52 Abdomen Do examine
53 X-ray USG MR scan Investigations Do examine
54 Take home message Good history & exam Do not forget other systems Conservative tt. is not panacea Not everything is frozen shoulder!
55
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