Shoulder Exam I
Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA
Examination of the shoulder can be complex, because it actually consists of four separate joints: are the glenohumeral (GH) joint, the acromioclavicular (AC) joint, the sternoclavicular joint, and the scapulothoracic joint. The GH joint is primarily responsible for shoulder motion and is the most mobile joint in the body. It has been likened to a golf ball sitting on a tee and is prone to instability. It is held in place by the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis), along with the GH ligaments.
The shoulder exam begins with the inspection and palpation of the key anatomic landmarks, followed by an assessment of the patient's range of motion. The opposite shoulder should be used as the standard to evaluate the injured shoulder, provided it has not been previously injured.
1. Inspection
- Look at both exposed shoulders in the front and in the back, and compare for asymmetry. Muscle atrophy may suggest rotator cuff tear with disuse or a nerve injury. Keep in mind that asymmetry may be seen due to adaptive hypertrophy of the throwing shoulder in an athlete. Venous distension may suggest effort thrombosis (often only with exertion).
- Note the presence of ecchymosis and swelling. Ecchymosis or swelling around the shoulder may suggest trauma or muscle tear.
Examination of the shoulder is done best by following a stepwise approach. It is important to have the patient remove enough clothing so the surface anatomy can be seen and compared to the uninvolved side. The exam should begin with inspection, looking for asymmetry between the involved and uninvolved shoulders. Next comes the palpation of the key structures, looking for tenderness, swelling, or deformity. This is followed with an assessment of the ROM, first actively and then passively, if the patient is unable to move
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