EXAMINATION AND ASSESSMENT

OF SHOULDER

- NITHIN NAIR ( MPT - I )

 OVERVIEW

FUNCTIONAL OUTCOME
SPECIAL TESTS
ANATOMY MEASURES

SUBJECTIVE
EXAMINATION
EXAMINATION

OBSERVATION PALPATION
GLENOHUMERAL JOINT

RESTING POSITION 40° to 55° abduction, 30° horizontal adduction

CLOSED PACK POSITION Full abduction, lateral rotation

CAPSULAR PATTERN Lateral rotation, abduction, internal rotation

ACROMIOCLAVICULAR JOINT

RESTING POSITION Arm resting by side in normal physiological position

CLOSED PACK POSITION 90° abduction

CAPSULAR PATTERN Pain at extreme of rom, especially horizontal adduction

and full elevation
STERNOCLAVICULAR JOINT

RESTING POSITION Arm resting by side in normal physiological position

CLOSED PACK Full elevation and pronation

POSITION

CAPSULAR PATTERN Pain at extreme of rom, especially horizontal adduction

and full elevation
SCAPULOTHORACIC ARTICULATION

 NOT A TRUE ARTICULATION/JOINT

LANDMARKS OF SCAPULA:

 SUPERIOR ANGLE @ T2

 MEDIAL SPINE @ T3

 INFERIOR ANGLE @ T7
 SUBJECTIVE EXAMINATION
Patient Profile/ Demographic data:

 AGE: Young/middle age adult: Ca++ (calcium) deposits (20-40yrs)

Middle age adult: RC cuff degeneration (40-60yrs)
Middle age/senior adult: frozen shoulder (adhesive capsulitis)
Shoulder dislocation: ↑ recurrence w/↑age

 GENDER: Females > males; prone to frozen shoulder

 OCCUPATION: Overuse – overhead activities

Acute trauma – fall on outstretched hand

 DOMINANCE: Dominant shoulder lower than Non Dominant shoulder

ROM ≠ Both sides
Dominant shoulder shows greater muscularity
 SUBJECTIVE EXAMINATION
Area of symptoms

 Referred from G-H Joint & Sub-acromion space

 Referred from A-C (acromioclavicular) Joint

 Referred from S-C (sternoclavicular) Joint

 Referred from Shoulder /Scapular muscles

 SUBJECTIVE EXAMINATION

Type/Description of Symptoms:
 Deep, boring, toothache-like pain – TOS
 Dull toothache-like pain (> night) – Rotator cuff
 Burning type of pain – acute calcific tendinitis
 Clicking, Popping
 Heaviness, Weakness “Dead-Arm” Syndrome
 Locking
 Apprehension
 Painful Arc
 SUBJECTIVE EXAMINATION
Behaviour of symptoms

What are the Aggravating Factors??

What are the Relieving Factors??

24hr pattern
 SUBJECTIVE EXAMINATION
 Aggravating factors:
 Reach up, across, behind
 Carrying
 Lifting
 Throwing
 Sleeping – on shoulder, back
 Cervical movements -aggravating, ease
 Relieving factors
 Rest
 Support
• Position
• Pillow
• Sling
 PAST HISTORY
 Related to area of complaint
 Related to other areas – sources of referral

 History of CNS, PNS (peripheral nervous system)

involvement
 SHOULDER O/E: OBSERVATION

 Limb position (either side/held across/support by other hand),

Gait (check arm swing during walking, dressing and general
willingness to use arm)
 Cervical & Thoracic spine curves
 A-C Joint
 Scapulae position, movement (scapulohumeral rhythm)
 Assistive devices (splints/orthosis/ modified)
 Functional Assessment – Hand to opp. Shoulder, Hand behind
back, Hand behind head.
 PALPATION
Symptom assessment/provocation at regional structures
Note for any muscle spasm, tenderness, abnormal bumps,
temperature or other signs that may indicate source of pathology.
Begin with anterior structures and then working around to the
posterior structures.
Compare injured side to the unaffected side
 EXAMINATION
AROM (In standing or sitting) – check for willingness for the
movement, quality. Assess Scapulohumeral Rhythm.
PROM - check for quality, symptoms and end feel. ALSO
Comment on joint reactivity and irritability.
Passive accessory movement (joint play) – Glides of GH, AC
and SC Joint. (check for amplitude & pain)
Strength – Resisted Isometric testing (assess – strong/weak;
pain/painless)
Neurological examination: Check for sensations (dermatomes),
reflexes, myotomes
 SPECIAL TEST
ANTERIOR GH INSTABILITY

• Apprehension Crank test

• Anterior load and shift test
 SPECIAL TEST
POSTERIOR GH INSTABILITY

• Jerk test
• Posterior load and shift test.
 SPECIAL TEST
INFERIOR AND MULTIDIRECTIONAL GH STABILITY

• Sulcus sign
 SPECIAL TEST
ANTERIOR IMPINGEMENT

• Neer Impingement test

• Hawkins-Kennedy test
 SPECIAL TEST
POSTERIOR IMPINGEMENT

• Posterior internal impingement test

 SPECIAL TEST
LABRAL LESION

• Active compression test of O’Brien

• Kim test
 SPECIAL TEST
AC JOINT PATHOLOGY

• AC Crossover, Crossbody, or Horizontal adduction test.

• Paxinos Sign
 SPECIAL TEST
BICEPS

• Speed’s test
• Yergason’s test
 SPECIAL TEST
SUPRASPINATUS

• Empty Can (Jobe test)

• Drop arm test
 SPECIAL TEST
SUBSCAPULARIS

• Lift off sign

 SPECIAL TEST
INFRASPINATUS

• Infraspinatus test
 SPECIAL TEST
ROTATOR CUFF (IN GENERAL)

• Rent test
• Whipple test
 SPECIAL TEST
TRAPEZIUS

• Trapezius test (3 positions)

 SPECIAL TEST
SERRATUS ANTERIOR

• Punch out test

 SPECIAL TEST
NEUROLOGICAL FUNCTION

• Upper limb neurodynamic test

 SPECIAL TEST
THORACIC OUTLET SYNDROME

• Roos test (Elevated arm stress test)

• Adson maneuver