Shoulder Examination

Mechanical alignment

Assess bilateral upper limbs: Look for muscle wasting

Shoulder range of motion (ROM)

Shoulder Abduction

Shoulder Flexion

Shoulder range of motion (ROM)

Shoulder External rotation (ER)

Shoulder Internal rotation (IR)

Shoulder range of motion (ROM)

Shoulder Internal rotation (IR):

the degree of IR can be quantified relative to the position along the spine. The highest position up the spine is quantified as the endpoint value.

Shoulder IR: The model can IR to a level of T6

Shoulder impingement

Shoulder impingement test: Abduct arm to 90 degrees. Internally rotate the arm and assess for pain.

Shoulder rotator cuff strength

Supraspinatus: Resisted abduction with arm 90 degrees abducted & thumb pointing down (pronated)

Shoulder rotator cuff strength

Subscapularis: Lift off test. Arm internally rotated at the back with resisted lifting of the arm.

Resisted internal rotation with arm in abduction

Lift off test

Shoulder rotator cuff strength

Infraspinatus (IS)/Teres minor(TM): Resisted external rotation.

IS & TM is responsible for external shoulder rotation.

Lateral rotation lag sign (IS spring back): keep shoulder in external rotation, if shoulder rotates internally after releasing it is the sign of torn IS/TM as the unopposed agonistic subscapularis pulls the shoulder internally

Shoulder biceps tests

Speed: extend arm then resisted shoulder flexion with forearm supinated then pronated with elbow completely extended.

Yergasons: Resisted supination with forearm flexed and pronated while patient also laterally rotates arm.

Resisted arm flexion

Shoulder stability tests

Anterior apprehension: Abduct arm to 90 degrees and externally rotate while eliciting apprehension.

Posterior apprehension: sitting or standing the shoulder is elevated to 90 degrees and a posterior directed force is applied to the elbow while stabilizing the scapular with other hand and eliciting apprehension.

Inferior:

Pull down on arm while it is at the side of chest. Presence of sulcus indicative of inferior instability.

Anterior instability test

Inferior instability test

Shoulder Surgery

Shoulder Ultrasound