Orthopaedic PE
Shoulder Examination
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C
Cervical Spine
L
Lumbar Spine
S
Shoulder
H
Hip
K
Knee
Side examined
Left
Right
1
Look
Inspection
From the front
Normal
Deltoid wasting ('squared-off')
AC joint prominence
SC joint prominence
'Popeye' sign (LHB rupture)
Ant. axillary fold loss (pec major)
Swelling
Deltopectoral scar
From the side & behind
Normal
Scapular winging
Supraspinous fossa wasting
Infraspinous fossa wasting
Thoracic kyphosis
Arthroscopy scars
Previous surgery scar
2
Feel
Palpation
Non-tender
SC joint tenderness
Clavicle tenderness
AC joint tenderness
Subacromial tenderness
Greater tuberosity tenderness
Bicipital groove tenderness
Coracoid tenderness
Crepitus
3
Move
ROM & scapulothoracic rhythm
Full active ROM
Painful arc (60–120°)
High painful arc (150–180°)
Global restriction (active + passive)
↓ Flexion
↓ Abduction
↓ ER
↓ HBB
Goniometry
drag — active & passive
HBB — level reached
Upper thoracic
Mid-thoracic
TLJ
Mid-lumbar
Low lumbar
Sacrum
Active
Passive
Scapulothoracic rhythm
Normal ST rhythm
Abnormal ST rhythm
Shrug sign (early scapular elevation)
Static scapular winging
4
Power
Examine muscles
Rotator cuff power
MRC grade
Supraspinatus
5
4
3
≤2
Infraspinatus
5
4
3
≤2
Teres minor
5
4
3
≤2
Subscapularis
5
4
3
≤2
Shoulder girdle
if assessed
Deltoid normal
Deltoid weak
Pec major normal
Pec major weak / ruptured
Serratus ant. normal
Serratus ant. weak (winging)
Trapezius normal
Trapezius weak
Lat dorsi normal
Lat dorsi weak
5
Special tests
Impingement & tendon
Subacromial impingement
Neer's sign
–ve
+ve
Hawkins-Kennedy
–ve
+ve
AC joint
Scarf test
–ve
+ve
Biceps tendon & SLAP
Speed's test
–ve
+ve
Yergason's test
–ve
+ve
O'Brien's (SLAP)
–ve
+ve
6
Instability
Lie patient
Laxity
Sulcus sign
–ve
+ve (Gr I)
+ve (Gr II)
+ve (Gr III)
Load & shift
Anterior load & shift
–ve
+ve (Gr I)
+ve (Gr II)
+ve (Gr III)
Posterior load & shift
–ve
+ve (Gr I)
+ve (Gr II)
+ve (Gr III)
Apprehension & relocation
Anterior apprehension
–ve
+ve
Relocation (Jobe's)
–ve
+ve (relieved)
Posterior apprehension
–ve
+ve
Beighton's score
if MDI suspected
Beighton's score
0–4 (normal)
≥ 5 (hypermobile)
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