From the Guidelines
A comprehensive shoulder examination should include inspection, palpation, range of motion assessment, strength testing, and special tests, as it is essential to differentiate between various shoulder pathologies and guide treatment planning. The examination should begin with observation of the patient's shoulder for asymmetry, muscle atrophy, or abnormal positioning. Palpation for tenderness over the acromioclavicular joint, bicipital groove, and greater tuberosity is also crucial 1.
The assessment of active and passive range of motion in all planes, including forward flexion, abduction, external rotation, internal rotation, and extension, is vital. Strength testing of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) using resisted movements should also be performed. Special tests such as the Neer impingement test, Hawkins-Kennedy test, empty can test for supraspinatus pathology, and apprehension/relocation tests for instability should be included in the examination 1.
The Speed's and Yergason's tests can help evaluate biceps tendon pathology. It is essential to compare findings with the unaffected shoulder to establish a baseline for future comparison and treatment planning. Neurovascular assessment is also necessary to rule out cervical radiculopathy or thoracic outlet syndrome that may present with shoulder pain 1.
In cases where radiographs are noncontributory, and there is a suspicion of bursitis or long head of biceps tenosynovitis, MRI shoulder without contrast or ultrasound shoulder can be considered as equivalent options for further evaluation 1. However, the choice of imaging modality may depend on local expertise and the specific clinical question being addressed.
Key components of a shoulder examination include:
- Inspection for asymmetry, muscle atrophy, or abnormal positioning
- Palpation for tenderness over the acromioclavicular joint, bicipital groove, and greater tuberosity
- Assessment of active and passive range of motion in all planes
- Strength testing of the rotator cuff muscles
- Special tests for impingement, instability, and biceps tendon pathology
- Neurovascular assessment to rule out cervical radiculopathy or thoracic outlet syndrome.
From the Research
Importance of Shoulder Exam
- Shoulder pain is a common musculoskeletal complaint that can have a significant impact on a patient's ability to function and overall health 2.
- A thorough physical examination is crucial in making a correct diagnosis and distinguishing different etiologies of shoulder dysfunction 2, 3, 4, 5, 6.
Components of Shoulder Exam
- Inspection: visual examination of the shoulder joint and surrounding structures 3, 4, 6.
- Palpation: manual examination of the shoulder joint and surrounding structures to identify areas of tenderness or abnormality 3, 4, 6.
- Range of motion and strength testing: assessment of the patient's ability to move their shoulder and arm, and the strength of the surrounding muscles 3, 4, 5, 6.
- Stability assessment: evaluation of the shoulder joint's stability and integrity 3, 4, 6.
- Special tests: specific maneuvers used to isolate and diagnose particular shoulder pathologies, such as rotator cuff injury or shoulder instability 2, 3, 4, 5, 6.
Challenges in Diagnosing Shoulder Pathology
- The shoulder joint is a complex structure with many articulations, unique features, and anatomic relationships, making diagnosis challenging 3, 6.
- Many different structures are involved in shoulder function, making it difficult to identify a specific pathology 3, 6.
- A thorough understanding of shoulder anatomy and biomechanics is necessary to properly diagnose and treat shoulder conditions 2, 3, 6.