The likely diagnosis will have been derived from the history. 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. Reinold, dpt, atc, cscs2 brian cole, md, mba3 1champion sports. The muscles surrounding the joint undergo reflex spasm in response to pain originating in the joint, which in turn serves to immobilize the joint and thus reduce the pain. Examination of the shoulder joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient to expose their shoulders fully inspection look anterior, lateral, and posterior asymmetry or deformity scars or skin changes muscle bulk palpate temperature. With dvd containing narrated footage of examination techniques. If signs warrant, or if suspicion of meniscal lesions or instability arises. Joint infection, which is also called septic arthritis. Joint scarring, which can be due to an injury, previous surgery, or chronic inflammation. Clinical examination and manual therapy of the shoulder and. In each case it is important to be familiar with some basic examination tools that can help us confirm. 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. The ottawa knee rules a useful clinical decision tool. The physical examination of the glenohumeral joint.
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. To complete exam to complete my examination i would examine the joint above and joint below, and also do a full neurovascular exam distal to. The examiner should be behind the patient on the side to be examined. Feb 22, 20 shoulder examination for orthopedic students. Nov 11, 20 examination of shoulder joint medical videos usmle step 2 clinical skills. During this part of the examination, remind the patient to report if they feel any pain. Each joint can be briefly checked in a systematic manner as the focus narrows to the source of the problem. Briefly explain to the patient what the examination involves. The etiology is most of the time traumatic and related either to sport or accidents.
At the conclusion of this program, the learner will be able. It stabilizes the shoulder joint by giving attachment to the ligaments. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. Examination of shoulder joint medical videos usmle step 2 clinical skills.
The superficial structures that should be evaluated are the sternal notch. Youll be expected to pick up the relevant clinical signs using your examination skills. Physical examination of the shoulder musculoskeletal key. Shoulder examination instructions examine the shoulder joint of this patient examiner summarise your. General principles musculoskeletal exam performed if. The shoulder is a complex joint, with a wide range of motion and functional demands. Your instructor may perform certain maneuvers differently than depicted here. Often, the clinical diagnosis of instability is difficult because of. Mark stovak demonstrates how to conduct a musculoskeletal physical exam on the neck and shoulder. This article summarizes the overall assessment of the shoulder joint and seeks to help direct clinicians to diagnose shoulder pathology using standard and specific physical examinations. Joint examination an overview sciencedirect topics. Painful resisted abduction and external rotation, tested by pressing outward against resistance, is suggestive of rotator cuff disease. Clinical examination of the shoulder girdle a shoulder examination or shoulder exam is a portion of a physical examination used to identify potential pathology involving the shoulder.
Other orthopedic history surgeries, arthritis, trauma, injuries etc physical exam. The clinical examination of the rheumatic disease patient. The ini tial impression can be divided into static and dynamic factors. Laxity, instability, and superior labral anterior and posterior slap lesions t.
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. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration. This form is a comprehensive checklist of examination procedures. An understanding of the intricate network of bony, ligamentous, muscular, and neurovascular anatomy is required in order to properly identify and diagnose shoulder pathology. Some differences can occur due to shoulder dominance. Active range of motion testing is usually performed first to allow. The range of the internal and external rotation of the shoulder is of clinical and functional importance. How i do a 5 minute comprehensive examination of the shoulder c. Clinical examination and manual therapy of the shoulder. Shoulder examination orthopaedics this video produced by students at oxford university medical school in conjunction with the faculty demonstrates how to. The glenohumeral joint is highly mobile with a tradeoff of poor stability, hence integrity of the static and dynamic shoulder stabilisers is essential. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting. How i do a 5 minute comprehensive examination of the.
The shoulder is a complex joint and, by virtue of having a large range of motion, is inherently unstable, relying on the surrounding soft tissue structures for stability. Shoulder pain is one of the most common complaints in the outpatient setting. Check out the shoulder examination mark scheme here. Joint aspiration offers both diagnostic and therapeutic benefits when managing joint effusion or inflammation. 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. Acute shoulder injuries in adults are often initially managed by family physicians. Shoulder examination a free powerpoint ppt presentation displayed as a flash slide show on id. Meyers, md from orthopaedic research of virginia, richmond, virginia. Diagnostically, the procedure permits acquisition of synovial fluid for analysis. Acute shoulder injuries in adults american academy of. Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. Examination of the biceps tendon and superior labrum anterior and posterior slap lesions 7.
Shoulder exam stanford medicine 25 stanford medicine. The rotator cuff consists of the teres minor, supraspinatus, deltoid and infraspinatus muscles. Swelling of the shoulder joint may be visible due to a joint effusion, or synovial thickening. Initial assessment of the injured shoulder pdf 431kb. It is the role of primary care, orthopaedic and rheumatological clinicians to assess complaints relating to the shoulder in a systematic manner. The shoulder joint is one of the more mobile joints in the body and restriction can have a significant effect on functional ability 1, 2. The key principle with this phase of the shoulder examination is symmetry. The shoulder is often considered a difficult joint to examine, and this is partly due to the large num ber of different clinical tests of shoulder function. 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. The diagnosisdriven physical exam of the shoulder april 24, 2014 carlin senter md, natalie voskanian md, veronica jow md. The shape, position and function of each shoulder should be relatively similar. Each item should be utilized as a diagnostic option based on the patients presenting. The diagnosisdriven physical exam of the shoulder april 24, 2014. For shoulder ailments, always start at the level of the.
The tradeoff for this freedom of motion is a relative lack of stability, which makes the. Instability the common disorders arise from diseases of the following structures. How i do a 5 minute comprehensive examination of the shoulder. Ppt shoulder examination powerpoint presentation free.
Clinical examination and manual therapy of the shoulder and shoulder girdle diagnose precisely. Joint inflammation, most commonly of the knee, shoulder, elbow, wrist or ankle. 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. Clinical assessment of the shoulder sta healthcare. Shoulder pain leads many patients to see a primary care physician. Place 1 hand behind the back and push out against resistance. Primary care sports medicine fellow steadman hawkins clinic of the carolinas. The static stabilisers act independently of the shoulder position. 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. Laure gossec, in handbook of systemic autoimmune diseases, 2018.
Bobby masocol md primary care sports medicine fellow steadman. Inflammation can be caused by a variety of conditions, such as rheumatoid arthritis, bursitis, and lupus. Gp assessment of the shoulder keith littlebury msc grad dip phys extended scope physiotherapist. Joint examination is the key element in ra because the objective of treatment is abrogation of synovitis. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination5 minute office exam visual inspection palpation motion cuff. Other causes are degenerative joint disease and arthritis. The physical examination begins when the patient is first seen by the physician. Whole shoulder frozen shoulder superior shoulder ac joint. Examination keys to evaluating any joint area well exposed. The first step of shoulder examination is to have the patient undress. State to the examiner that to complete your examination you would also like to examine the joint above and below elbow and cervical spine, the contralateral. Checklist for physical examination of the shoulder musculoskeletal block chris mcgrew md, andrew ashbaughdo this handout is for use as a rough guide and study aid. 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.
The necessary skills can be developed by examining colleagues or patients. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral. Therapeutically, joint aspiration in the face of painful effusion relieves the patients discomfort and may facilitate a more accurate joint examination. Examination may report clunking some mild instability sensations. Greater and lesser tuberosity, feel for rotator cuff defects. Wright, md this article summarizes the overall assessment of the shoulder joint and seeks to help direct. For any musculoskeletal condition, especially one that is associated with the shoulder joint, it is important to obtain a thorough history and physical examination, both of which are essential to reaching a diagnosis. The joint is sensitive to pain, pressure, excessive traction, and distension. Clinical examination of the shoulder joint complex kevin e. Joints are counted as swollen, if there is clinical synovitis, and as tender, if patients report pain on soft palpation of the joint.
Bobby masocol md primary care sports medicine fellow. Arrigo, ms, pt, atc he physical examination of patients whose com plaints suggest subtle to moderate shoulder insta bility can be extremely difficult. Deformity of the joint and fractures and dislocations are usually obvious figure 37a,b. In the clinic, the axial rotational range is used in shoulder examinations to test for.