From the Guidelines
A thorough shoulder examination should include a physical examination with neurological screening tests, assessment of mobility, and muscle strength, as recommended by high-quality clinical practice guidelines 1.
Key Components of a Shoulder Examination
The examination should begin with:
- Inspection for asymmetry, muscle atrophy, or deformity
- Palpation of key structures including the AC joint, bicipital groove, and greater tuberosity
- Range of motion testing to assess active and passive movement in all planes:
- Forward flexion (0-180°)
- Abduction (0-180°)
- External rotation (0-90°)
- Internal rotation
- Extension
Special Tests
Special tests should include:
- Impingement tests (Neer and Hawkins-Kennedy)
- Rotator cuff strength testing (Jobe's test for supraspinatus, external rotation for infraspinatus, lift-off test for subscapularis)
- Instability tests (apprehension, relocation, and load-and-shift tests)
- Labral tests (O'Brien's and Speed's tests)
- AC joint assessment (cross-body adduction)
Comparison and Progression
Always compare findings with the unaffected shoulder to establish baseline function. The examination should be systematic and thorough, progressing from simple observation to more complex maneuvers, with attention to pain patterns and mechanical symptoms 1. This approach allows for accurate diagnosis of common shoulder pathologies, including rotator cuff tears, impingement syndrome, instability, and labral injuries, guiding appropriate treatment decisions.
From the Research
Steps for Conducting a Thorough Shoulder Examination
The following steps are involved in conducting a thorough shoulder examination:
- Inspection: visual examination of the shoulder to identify any abnormalities or deformities 2, 3, 4
- Observation: observing the patient's posture, movement, and function to identify any limitations or abnormalities 3, 5
- Palpation: manual examination of the shoulder to identify any areas of tenderness or abnormality 2, 3, 4
- Manual muscle testing: testing the strength and function of the muscles around the shoulder joint 2, 3
- Special testing: performing specific tests to assess the function and integrity of the shoulder joint, such as stability and range of motion tests 2, 3, 4
- Neurological testing: testing the nerve function and sensation around the shoulder joint 3, 5
- Examination of joints above and below the shoulder: examining the neck, thoracic spine, and elbow to identify any referred pain or abnormalities that may be contributing to shoulder symptoms 3, 5
Key Components of a Shoulder Examination
A thorough shoulder examination should include:
- A systematic approach to the examination, correlating the various maneuvers and tests with the anatomy and pathology of the shoulder 2, 6
- A combination of general inspection, palpation, and special testing to improve diagnostic accuracy 4
- An understanding of the complex anatomy and biomechanics of the shoulder joint to interpret the examination findings accurately 6, 5