From the Guidelines
A comprehensive shoulder physical assessment is crucial for evaluating function and identifying potential pathologies, and it should include a detailed patient history, visual inspection, range of motion testing, strength testing, special tests, palpation, and a thorough neurovascular examination. When performing a shoulder physical assessment, it is essential to consider the patient's history, including pain characteristics, functional limitations, previous injuries, and occupational/recreational activities 1. The assessment should begin with a visual inspection to evaluate posture, muscle atrophy, scapular positioning, and any obvious deformities. Range of motion testing, both active and passive, should be performed to evaluate forward flexion, abduction, internal/external rotation, and cross-body adduction, comparing findings to the unaffected side. Strength testing should assess the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and other shoulder girdle muscles using manual resistance. Special tests are essential and should include impingement tests (Neer, Hawkins-Kennedy), rotator cuff integrity tests (Empty can, External rotation lag sign), labral tests (O'Brien's, Anterior slide), instability tests (Apprehension, Relocation), and AC joint assessment (Cross-body adduction) 1. Palpation should identify tender areas around the glenohumeral joint, AC joint, bicipital groove, and surrounding musculature. A thorough neurovascular examination should check sensation, reflexes, and circulation. This systematic approach ensures comprehensive evaluation of all shoulder structures and helps differentiate between various pathologies that can present with similar symptoms. Some key components of the assessment may include:
- Detailed patient history
- Visual inspection
- Range of motion testing
- Strength testing
- Special tests
- Palpation
- Neurovascular examination It is also important to note that imaging studies, such as radiography, MRI, or CT, may be necessary to further evaluate the shoulder and confirm the diagnosis, as recommended by the American College of Radiology 1.
From the Research
Key Components of a Comprehensive Shoulder Physical Assessment
The key components of a comprehensive shoulder physical assessment include:
- Inspection: visual examination of the shoulder joint and surrounding area
- Palpation: manual examination of the shoulder joint and surrounding area to identify areas of tenderness or abnormality
- Assessment of range of motion: evaluation of the patient's ability to move their shoulder through a full range of motion
- Assessment of strength: evaluation of the patient's shoulder strength and stability
- Neurovascular integrity: assessment of the nerves and blood vessels surrounding the shoulder joint
Specific Tests Used in Shoulder Physical Assessment
Specific tests used in shoulder physical assessment include:
- Neer test: used to diagnose subacromial impingement syndrome 2
- Hawkins test: used to diagnose subacromial impingement syndrome 2
- Jobe's test: used to evaluate the supraspinatus muscle 3
- Patte's test: used to evaluate the infraspinatus muscle 3
- Lift-off test: used to evaluate the subscapularis muscle 3
- Speed test: used to diagnose superior labral anterior to posterior (SLAP) lesions 4
Importance of Physical Examination in Diagnosing Shoulder Pathology
Physical examination is important for making an accurate diagnosis and distinguishing certain pathologies of the shoulder 5, 6. A thorough understanding of the network of bony, ligamentous, muscular, and neurovascular anatomy is required to properly identify and diagnose shoulder pathology 6. The diagnostic accuracy of physical examination tests of the shoulder is limited, and there is a need for large, prospective, well-designed studies to examine the diagnostic accuracy of these tests 4.