Shoulder Exam

Introduces self	0	1
Confirms name & age of patient	0	1
Explains & gains consent	0	1
Asks if patient suffers from pain, stiffness or reduced range of movement in the shoulder	0	1
Washes hands	0	1
Exposes patient’s shoulders and the joints more proximal and distal (back, elbow and hand) and asks them to stand	0	1
General inspection around bed and patient (walking aids, obvious scars, wasting or deformities)	0	1
Inspects front for shoulder/hip alignment, limb-limb discrepancy, shoulder architecture	0	1
Inspects back for wasting of muscles (trapezius, paraspinal, deltoids), scoliosis, skin changes, scars, winging of scapulae	0	1
Inspects sides for fixed flexion deformities, increased kyphosis or lordosis, carrying angle of the elbow	0	1
Palpates for temperature	0	1
Palpates the shoulder joints for tenderness/effusions from the sternoclavicular joint, along the clavicle, acromioclavicular joint and acromion. Also feel the joint line, the tuberosities and the glenohumeral joint and scapulae	0	1	2
Palpates the biceps tendon for tendonitis	0	1
Assesses function by asking patient to place their hands behind their head and behind their back as far up as they can go	0	1	2
Assesses active abduction (normal: 180 degrees) observing for a painful arc. Repeat passively observing movement of scapula and feeling for crepitus	0	1	2
Assesses active adduction (50 degrees) by moving arms towards the midline and across the chest. Extend passively if required.	0	1
Assesses active flexion (165 degrees) and extension (65 degrees). Extend passively if required.	0	1	2
Assesses external rotation (60 degrees) by asking patient to tuck their elbows in and rotate out. Extend passively if required. Marked loss in adhesive capsulitis or ‘frozen shoulder’	0	1
Assesses supraspinatus by asking patient to extend their arms and abduct 90 degrees, internally rotate slightly with thumbs pointing down. Test their strength by asking patient to resist you pushing down.	0	1
Assesses infraspinatus and teres minor by asking patient to flex their elbow by 90 degrees and abduct their shoulder 30 degrees. Test their strength by asking patient to externally rotate against your hands	0	1
Assesses subscapularis by asking patient to place their hands behind their back palmar surfaces outwards. Ask them to push away from their body whilst you resist to test their strength	0	1
Offers the apprehension test for anterior dislocation. Have patient standing with elbows 90 degrees flexed. Abduct and externally rotate the shoulder with one hand whilst applying pressure over the head of the humerus in an anterior direction	0	1	2
Offers Hawkin's test/Neer’s test and Scarf test	0	1
Offers examination of back and elbow exam, neurovascular exam and history	0	1
Thanks patient and offers help to redress	0	1
Washes hands	0	1
Offers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft tissue)	0	1
Summarises appropriately with only key findings	0	1
Offers appropriate differential diagnoses	0	1

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