Shoulder examination

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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.

Physical examination Process by which a medical professional investigates the body of a patient for signs of disease

A physical examination, medical examination, or clinical examination is the process by which a medical professional investigates the body of a patient for signs of disease. It generally follows the taking of the medical history—an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record.

Shoulder part of the body

The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. The shoulder is the group of structures in the region of the joint.

Contents

Elements of the shoulder exam

Inspection organized examination or formal evaluation exercise

An inspection is, most an organized examination or formal evaluation exercise. In engineering activities inspection involves the measurements, tests, and gauges applied to certain characteristics in regard to an object or activity. The results are usually compared to specified requirements and standards for determining whether the item or activity is in line with these targets, often with a Standard Inspection Procedure in place to ensure consistent checking. Inspections are usually non-destructive.

Palpation process of using ones hands to examine the body, especially while perceiving/diagnosing a disease or illness

Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine its size, shape, firmness, or location.

Clavicle plain bone of short length that serves as a strut between the scapula and the sternum

The clavicle or collarbone is a long bone that serves as a strut between the shoulder blade and the sternum or breastbone. There are two clavicles, one on the left and one on the right. The clavicle is the only long bone in the body that lies horizontally. Together with the shoulder blade it makes up the shoulder girdle. It is a touchable bone and in people who have less fat in this region, the location of the bone is clearly visible, as it creates a bulge in the skin. It receives its name from the Latin: clavicula because the bone rotates along its axis like a key when the shoulder is abducted. The clavicle is the most commonly fractured bone. It can easily be fractured due to impacts to the shoulder from the force of falling on outstretched arms or by a direct hit.

Provocative maneuvers specific to the shoulder examination

Tests for rotator cuff pathology

The Empty can test and Full can test are used to diagnose shoulder injuries. Specifically, these physical examination maneuvers examine the integrity of the supraspinatus muscle and tendon.

Rotator cuff tear Rotator cuff tear

A rotator cuff tear is an injury of one or more of the tendons or muscles of the rotator cuff of the shoulder. Symptoms may include shoulder pain, which is often worse with movement, or weakness. This may limit peoples’ ability to brush their hair or put on clothing. Clicking may also occur with movement of the arm.

Supraspinatus muscle muscle of the upper back

The supraspinatus is a relatively small muscle of the upper back that runs from the supraspinatous fossa superior portion of the scapula to the greater tubercle of the humerus. It is one of the four rotator cuff muscles and also abducts the arm at the shoulder. The spine of the scapula separates the supraspinatus muscle from the infraspinatus muscle, which originates below the spine.

Tests for bicipital tenosynovitis and labral pathology

Yergason's test is a special test used for orthopedic examination of the shoulder and upper arm region, specifically the biceps tendon.

SLAP tear

A SLAP tear or SLAP lesion is an injury to the glenoid labrum. SLAP is an acronym for "superior labral tear from anterior to posterior".

Tests for shoulder instability

Jobe's test may refer to:

Other tests

Acromioclavicular joint

The acromioclavicular joint, or AC joint, is a joint at the top of the shoulder. It is the junction between the acromion and the clavicle. It is a plane synovial joint.

Adsons sign

Adson's sign is the loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration.

Lhermitte's phenomenon or the Lhermitte phenomenon, sometimes called the barber chair phenomenon, is an uncomfortable "electrical" sensation that runs through the back and into the limbs. The sensation can feel like it goes up or down the spine.

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]

Related Research Articles

Humerus long bone of the upper arm

The humerus is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a rounded head, a narrow neck, and two short processes. The body is cylindrical in its upper portion, and more prismatic below. The lower extremity consists of 2 epicondyles, 2 processes, and 3 fossae. As well as its true anatomical neck, the constriction below the greater and lesser tubercles of the humerus is referred to as its surgical neck due to its tendency to fracture, thus often becoming the focus of surgeons.

Shoulder problem

Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.

Suprascapular nerve

The suprascapular nerve is a nerve that arises from the brachial plexus. It is responsible for the innervation of some of the muscles that attach on the scapula, namely the supraspinatus and infraspinatus muscles.

Shoulder joint

The shoulder joint is structurally classified as a synovial ball and socket joint and functionally as a diarthrosis and multiaxial joint. It involves articulation between the glenoid cavity of the scapula and the head of the humerus.

Subscapularis muscle Large triangle muscle of the shoulder

The subscapularis is a large triangular muscle which fills the subscapular fossa and inserts into the lesser tubercle of the humerus and the front of the capsule of the shoulder-joint.

Shoulder girdle set of bones which connects the arm to the axial skeleton on each side

The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of the clavicle, scapula, and coracoid. Some mammalian species have only the scapula.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

Subacromial bursitis

Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament, acromion, and coracoid and from the deep surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work.

Radiculopathy Human disease

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. This can result in pain, weakness, numbness, or difficulty controlling specific muscles.

Cervical spinal nerve 6 spinal nerve of the cervical segment

The cervical spinal nerve 6 (C6) is a spinal nerve of the cervical segment.

Shoulder impingement syndrome is a syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. This can result in pain, weakness and loss of movement at the shoulder.

The drop arm test is designed to determine a patient's ability to sustain humeral joint motion through eccentric contraction as the arm is taken through the full motion of abduction to adduction. It will determine if the patient has an underlying rotator cuff dysfunction.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

The Hawkins–Kennedy Test is a test used in the evaluation of orthopedic shoulder injury. It was first described in the 1980s by American Drs. R. Hawkins and J. Kennedy, and a positive test is most likely indicative of damage to the tendon of the supraspinatus muscle.

References

  1. THOMAS W. WOODWARD, M.D.; THOMAS M. BEST, M.D. (May 15, 2000). "The Painful Shoulder: Part I. Clinical Evaluation". Am Fam Physician. 61 (10): 3079–3088. PMID   10839557.
  2. "Musculoskeletal Shoulder Examination: Shoulder Exam Maneuvers". University of Michigan. Retrieved 5 August 2013.
  3. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, Cook C. (February 2008). "Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests". Br J Sports Med. 42 (2): 80–92, discussion 92. doi:10.1136/bjsm.2007.038406. PMID   17720798.
  4. Edward G. McFarland; Tae Kyun Kim (30 June 2006). Examination of the shoulder: the complete guide. Thieme. ISBN   978-3-13-141091-7 . Retrieved 25 June 2011.