With dvd containing narrated footage of examination techniques. The upper limb examination is another skill to elicit neurological signs, such as nerve problems that supply the arms and hands. When assessing shoulder pain, a structured physical examination, as directed by the patients history, allows the clinician to look for important diagnostic clues. Physical examination and common pathological conditions of the shoulder mr p sarda consultant orthopaedic surgeon cmft epidemiology 2nd only to knee pain for specialist referrals most common causes in adults peak age 4060 subacromial impingement syndrome rotator cuff related 2040 years instability calcific. How i do a 5 minute comprehensive examination of the shoulder. The physical examination includes observing the way the patient moves and carries the shoulder.
The view from the side detects any recurvatum or lack of complete extension. Acute shoulder injuries in adults are often initially managed by family physicians. The first is to identify orthopedic shoulder physical examination special tests with the best clinical utility statistics to ease the diagnostic process through usage of an examination algorithm. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuffspecific testing biceps testing. Physical examination tests of the shoulder pets are clinical examination maneuvers designed to aid. This video aims to give you an idea of whats required in the osce and you can then.
Instability the common disorders arise from diseases of the following structures. Shoulder disorders are can be broadly classified into the following types. How i do a 5 minute comprehensive examination of the shoulder c. Explain the examination, obtain consent and a chaperone and then proceed to wash hands. The patient may report that the test feels the same as when the shoulder. November 27, 2016 december 8, 2018 admin history taking and physical examination pdf clininical examination rheumatology systematic musculoskeletal examinations 2012 pdf. An understanding of the intricate network of bony, ligamentous, muscular, and neurovascular anatomy is required in order to properly identify and diagnose shoulder pathology.
Examination of the biceps tendon and superior labrum anterior and posterior slap lesions 7. Clinical assessment of the shoulder sta healthcare. Resisted flexion resistance is applied to the palmar aspect of the distal phalanx. The necessary skills can be developed by examining colleagues or patients. The complete guide is written in a userfriendly format. The second is to expedite the diagnostic process by guiding the practitioner to select only the special tests that are necessary based on pattern. The patient, aged 60, who presents with shoulder pain should have a thorough neurological examination involving the upper extremity to rule out possible neurological cause of the pain. Shoulder examination instructions examine the shoulder joint of this patient examiner summarise your. How i do a 5 minute comprehensive examination of the. The posterior force is maintained while the arm is brought into the extreme of external rotation. Information gathered in this process can help guide. Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently. The complex structure of the shoulder, with its variable pathological conditions of rotator cuff disease, degenerative joint disease, and type ii slap lesions, makes clinical examination and assessment difficult for both new and experienced practitioners.
Laxity, instability, and superior labral anterior and posterior slap lesions t. Special tests impingement, cuff, labrum, instability 5. Nov 28, 2012 this video produced by students at oxford university medical school in conjunction with the faculty demonstrates how to perform an orthopaedic examination of the shoulder joint. We limit our focus to the shoulder girdle, which includes the sternoclavicular, acromioclavicular ac, glenohumeral, and scapulothoracic st joints. The large number of shoulder examination techniques, often named. Clinical examination follows the order of inspection, palpation, assessment of range of motion and special tests for the shoulder.
Examination of the shoulder joint teachmesurgeryteachmesurgery. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration. Tingling pins and needles in your arm, shoulder or hand. Clinical examination of the wrist, thumb and hand c h a p t e r 2 0 323 thumb the extensor pollicis longus and extensor pollicis brevis fig. Bobby masocol md primary care sports medicine fellow. Chapter 1 addresses general principles of shoulder examinations and provides an overview of the process, which establishes a foundation for the rest of the text. Table 4 provides details of the muscles of the shoulder and figure 38ad illustrations of the anterior and posterior bones and muscles of the upper limb. Shoulder examination osce guide old version youtube. Ask whether the patient is in any pain, especially in the shoulder area, and ask them to report if they have any pain at any point of the examination. Meyers, md from orthopaedic research of virginia, richmond, virginia.
Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. The examination of all joints follows the general pattern of look, feel, move as well as occasionally special tests, in which this station has many. Khosravi, ms, venkat almareddi, md, vinodhkumar pannirselvam, md, and edward g. Drogset3,4, fredrik granviken1, magne ro1 and gunnar leivseth5,6 abstract background. Local pain or discomfort and a look of apprehension on the patients face indicates chronic posterior shoulder instability. Swelling of the shoulder joint may be visible due to a joint effusion, or synovial thickening.
Examination of the shoulder article in techniques in shoulder and elbow surgery 124. Check out the shoulder examination mark scheme here. In each case it is important to be familiar with some basic examination tools that can help us confirm the presence of a shoulder lesion. Aug 24, 2015 the ability to carry out a thorough and slick shoulder examination is something every medic needs to master.
The recommended progression of shoulder examination maneuvers is inspection, palpation, range of motion and strength tests, and provoca tive tests. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. The shoulder examination, along with all other joint examinations, is commonly tested on in osces. Shoulder complaints often present and a sound and confident approach to the shoulder assessment is important. Introduce yourself, confirm the patients name and date of birth.
The large number of shoulder examination techniques, often named for their originators, can be confusing. Mastery of the shoulder examination is recommended in the association of american medical colleges musculoskeletal content report. Skillful examination of the shoulder is an integral part of this evaluation and is necessary to generate an appropriate differential diagnosis and to help determine whether advanced imaging is needed. The patient should be properly disrobed to permit complete inspection of both shoulders. Youll be expected to pick up the relevant clinical signs using your examination skills.
Having a systematic and structured approach to the shoulder history and examination ensures that key aspects of the condition are elicited and important conditions are not missed. A thorough examination of shoulder symptoms should include the cervical spine, contralateral shoulder, elbow, trunk, and upperlimb neurovascular structures. Pdf this article summarizes the overall assessment of the shoulder joint and seeks to help direct clinicians to diagnose shoulder pathology. Deformity of the joint and fractures and dislocations are usually obvious figure 37a,b. The difficult development of the shoulder, with its variable pathological circumstances of rotator cuff sickness, degenerative joint sickness, and type ii slap lesions, makes medical examination and analysis troublesome for every new and expert practitioners.
The shoulder is a complex joint, with a wide range of motion and functional demands. Despite more than 180 pets described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is. The etiology is most of the time traumatic and related either to sport or accidents. In this series, a normal test result was seen in 100 patients who had no shoulder complaints, 27 patients with a fullthickness rotator cuff tear not involving the sub. The 7 chapters of this book are organized in a logical progression.
Resisted shoulder tests abdn, med rotn, lat rotn 4. Physical examination of the shoulder free medical books. In addition, imaging for impingement, rotator cuff injury, instability, labral tears and acromioclavicular disorders may provide falsepositive and falsenegative results, and it has therefore been proposed that traditional clinical examination of the shoulder should remain the corner stone for diagnosis. Shoulder pain leads many patients to see a primary care physician. Other causes are degenerative joint disease and arthritis. Pdf physical examination of the shoulder researchgate. The acromioclavicular and sternoclavicular joints appendix. Discussion a description of the different tests is given, with photographs of the exact test procedure. Mcfarland, md introduction t he examination of the shoulder complex is a challenge for many practitioners. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint ten derness, and a painful crossbody adduction test. Dec 18, 2015 shoulder examination is a practical skill which requires background knowledge of anatomy, of normal shoulder function and of abnormalities affecting the shoulder. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
Shoulder exam stanford medicine 25 stanford medicine. Meyers, md from orthopaedic research of virginia, richmond, virginia careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. Physical examination tests of the shoulder pets are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Upper limb neurological examination neurology osce. The past, the present, and the future by xiaofeng jia, md, phd, steve a. Feb 22, 20 shoulder examination for orthopedic students. Competency based clinical shoulder examination training. The likely diagnosis will have been derived from the history. The patient may report that the test feels the same as when the shoulder was dislocated. Arm, shoulder or hand pain when you performed any specific activity. Bobby masocol md primary care sports medicine fellow steadman. Place 1 hand behind the back and push out against resistance. Shoulder pain is one of the most common complaints in the outpatient setting.
Physical examination of the shoulder peter millett, md. A focused history is the most valuable yet least effectively used tool in clinical medicine. Patients may present with a number of complaints including altered sensation, for example. You should ensure you are able to perform this confidently.