Orthopaedic PE
Shoulder Examination
Side examined
1LookInspection
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
2FeelPalpation
Non-tender
SC joint tenderness
Clavicle tenderness
AC joint tenderness
Subacromial tenderness
Greater tuberosity tenderness
Bicipital groove tenderness
Coracoid tenderness
Crepitus
3MoveROM & 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
4PowerExamine muscles
Rotator cuff power MRC grade
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
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
5Special testsImpingement & tendon
Subacromial impingement
Neer's sign
Hawkins-Kennedy
AC joint
Scarf test
Biceps tendon & SLAP
Speed's test
Yergason's test
O'Brien's (SLAP)
6InstabilityLie patient
Laxity
Sulcus sign
Load & shift
Anterior load & shift
Posterior load & shift
Apprehension & relocation
Anterior apprehension
Relocation (Jobe's)
Posterior apprehension
Beighton's score if MDI suspected
Beighton's score
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