Shoulder Exam II

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The shoulder exam continues by checking the strength of the rotator cuff muscles and biceps tendons. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) act as compressors, holding the humeral head in place against the glenoid. Injury and degeneration of the rotator cuff tendons are the most common sources of shoulder pain.

The strength testing of the rotator muscle is performed by testing motions against resistance applied by the examiner. Pain with these resisted motions suggests tendonitis; weakness suggests a rotator cuff tear. The strength tested is followed by tests for impingement syndrome, shoulder instability, and labrum injury. It is important to test both of the shoulders and compare between the sides. The opposite shoulder should be used as the standard to evaluate the injured shoulder, provided it has not been injured as well.

1. Strength Testing of the Rotator Cuff Muscle

Strength testing of the rotator cuff is assessed using resisted motion. The following resisted motions should be tested:

External rotation: Ask the patient to bend both elbows to 90^o with arms hanging at the side, and then to push both hands away from the midline against resistance. This tests strength of the infraspinatus and teres minor.
Internal rotation: Ask the patient to bend both elbows to 90^o wit

The clinical evaluation of the shoulder begins with inspection, palpation, and testing range of motion, followed by strength testing of the rotator cuff and biceps muscles. While assessing the strength of the rotator cuff muscles, it is essential to differentiate true muscle weakness from a painful inhibition of strength that can be seen with severe tendonitis. The next part of the exam is the assessment for signs of impingement, using the Neer's, Hawkins, and crossover tests. Pain or lack of motion with these maneuv

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