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Examination of the Shoulder

  • Expose patient down to waist
  • Observe patient whilst undressing
    • Comment whilst patient is undressing
  • Stand near examiners

Look

Clues

  • Splint
  • Sling

Anterior Aspect

Make statement regarding patient overall health

  • e.g.
    • rheumatoid habitus
    • cushingoid
  • no obvious signs of systemic disease
  • Skin
    • scars, sinuses, swelling
    • Pigmentation, Ecchymosis, Erythema
  • Symmetry
    • Bone
      • Clavicle, Sternoclavicular Joint, ACJ, Acromion, Coracoid Process
    • Muscle Wasting
      • Trapezius, Deltoid, Pectoral contour, deltoid, Popeye deformity(more easily seen with elbow flexed)
  • Posture
    • Arm internally rotated
      • Posterior dislocation
  • This patient has no obvious signs of systemic disease
  • There is no obvious skeletal deformiy, muscle atrophy or asymmetry.
  • There are no scars , swellings or skin changes.

Please straighten your elbow

  • There is no popeye deformity

Lateral Aspect

Please turn around sir

  • Muscle Wasting
    • Deltoid, Biceps, triceps

There are no further scars or abnormalities

Posterior Aspect

Please turn around & face the back wall

  • Skin
  • Symmetry
    • Bone
      • Scapula
        • Height
        • Winging of scapula
        • Sprengel’s deformity
          • congenital malformation
          • scapula is smaller & carried higher than on the uninvolved side
        • Lateral scapular slide
          • Soft tissue contracture draws the dominant arm scapular away from midline, common in throwing athletes
          • ↑ 1.5cm correlates with posterior shoulder pain & anterior impingement syndrome
      • Spine
    • Muscle Wasting
      • Trapezius
      • Atrophy of supra / infraspinatus fossae
        • supraspinatus
        • infraspinatus
      • Triceps

There are no obvious skin changes,

there is normal symmetrical scapular contours

no wasting in the supraspinatus or infraspinatus fossae

Webpage Last Modified: 28 January, 2010