Physical Exams of the Shoulder

Welcome to The UW Shoulder Site @ uwshoulder.com

Please note that information on this site was NOT authored by Dr. Frederic A Matsen III and has not been proofread or intended for general public use. Information was intended for internal use only and is a compilation for random notes and resources.

If you are looking for medical information about the treatment of shoulders, please visit shoulderarthritis.blogspot.com for an index of the many blog entries by Dr. Frederick A Matsen III.

Physical Exams of the Shoulder

General Inspection

Observe how the patient moves as they go into the room or move from chair to table
General appearance
Body proportions

Posture

How is there handshake

Do they use their affected arm to help them on the exam table

Appearance

Look for asymmetry between sides
Swelling
Deformities
Atrophy
Erythema

Skin lesions

Palpation

When palpating a structure, you need to know the anatomy of that structure
Palpate for swelling
Palpate for warmth
Palpate each area of the structure in turn evaluating for pain, and abnormalities as compared to the other side

Palpation of the shoulder includes:
Sternoclavicular joint
Acromioclavicular joint
Subacromial area
Bicipital groove
Muscles of the Scapula

Range of Motion

Active

Observe and record the following on both shoulders:

FE

ERS

IR up back

Watch for decreased or increased movement of the joint compared to the other side as well as the norm
Watch for pain with movement
Listen for crepitus or “popping”
Watch for abnormal movements

Passive

Next range the joints passively, comparing the end points to the active

Grab the scapula to help isolate the glenerohumeral joint

FE

ERS

IRA

ERA

CBA - measure the distance from elbow fold to AC joint

Again note any decreased or increased movement
Pain with the movement
Crepitus or “popping”

Strength

Grade strength (0-5)

ER

IR into stomach

IR lift off

Supraspinatus (empty can/ Jobes) test: The shoulder is forward flexed at 30°, arms straight and thumbs pointing to ground, a downward force is applied to the arms. Tests for tear or weakness of the supraspinatus.

Stability

Apprehension (crank) test: The arm is abducted to 90° and laterally rotated. Positive test is when the patient has feeling as if the shoulder may “come out.”

Jobe relocation test: A posterior stress placed to the shoulder in the above position will cause relief of pain and apprehension if positive.

Rockwood test for anterior instability: Similar positioning as the crank test, but the shoulder is laterally rotated at 0, 45, 90, and 120°.

Rowe test for anterior instability: Patient supine with hand behind head. Examiners clenched fist placed behind the humeral head and a downward force is applied to the arm.

Fulcrum test: Patient supine arm abducted to 90°, examiners hand under the glenoid and the arm is laterally rotated.

Anterior and posterior drawer:

0-25% translation (normal)

25-50% (Grade I), >50% but spontaneously reduces (Grade II)

>50% remains dislocated (Grade III)

Feagin test: arm abducted to 90 elbow straight arm on examiner’s shoulder, a down and forward pressure is applied. Positive if apprehension and presence of anteroinferior instability.

Clunk test: Patient supine, examiner hand on the posterior aspect of the shoulder, other hand hold the humerus above the elbow and abducts the arm over the head. Then pushing anteriorly with the hand under the shoulder and rotating the humerus laterally with the other hand, feel for a grind or clunk which may indicate a tear of the labrum.

Compression rotation test: Patient supine, elbow flexed and abducted 20°, the examiner pushes up on the elbow and rotates the humerus medially and laterally. Snapping or catching is positive for labral tear.

Bicep Tests

Speed’s test: forearm supinated, elbow extended and resistance to forward flexion of the shoulder. Positive if tenderness in the bicipital groove indicating bicipital tendinitis.

Yergason’s test: Elbow flexed to 90°, forearm pronated, resistance to supination is applied as the patient also laterally rotates the arm. Positive if pain in the bicipital groove and indicates bicipital tendinitis.

Bicep Saw test: Pt flexes elbow to 90° places fist in examiners hand. Pt's fist if forces downward while making a saw motion FE to and from -30 and + 30°. Pain in bicepital groove sugestive of bicipital tendinitis.

Impingement Tests

Neer impingement test: Arm is elevated through forward flexion, positive if painful.

Hawkins-Kennedy impingement test: Arm is forward flexed to 90 then internally rotated, positive if painful.

Impingement test: Arm is abducted to 90 and full lateral rotation, positive if painful.

Other Tests

Scapular thoracic glide tests: To determine the stability of the scapula during glenohumeral movements.

O'Brien-Test: Pt flexes arm to 90° with elbow fully extended and then adduct the arm 10-15° medial to sagittal plane. Maxi pronation with FE against resistance - the repeated in supination. Pain with pronation and not supination is AC or labral lesion.

Codman’s (drop arm) test: shoulder is abducted to 90° and patient asked to lower the arm slowly. If drops or is painful, it is positive and indicates tear in the rotator cuff.

Military brace (Costoclavicular Syndrome) test: Palpate the radial pulse as the shoulder is drawn down and back. Positive if a decreased pulse and indicates possible thoracic outlet syndrome.

Adson Maneuver: radial pulse palpated as arm is rotated laterally and elbow is extended as the patient extends and rotates head to test shoulder.

Allen test: Elbow is flexed to 90, shoulder abducted and laterally rotated and patient rotates head away for the test side.

Halstead maneuver: Radial pulse felt as arm is pulled down as the patients neck is hyperextended and rotated to the opposite side.

Neurological

Grade reflexes (0-4)
Sensory exam

Neck Tests

ROM

Chin to chest (flexion)
“look at ceiling” (extension)
Chin to each shoulder (lateral rotation)
Ear to each shoulder (lateral flexion, i.e., head tilt)

Dekleyn test: head and neck rotation with extension. Tests for vertebral artery compression.

Spurlin’s: (foraminal compression test): patient extends rotates head to side, the examiner then applies axial load to the head. Positive test is when there is pain radiating into arm. Indicates Pressure on a nerve root.

Elvey test: (upper limb tension tests): tests designed to put stress on the neurological structures of the upper limb.
Median nerve C5,6,7
Median nerve, axillary nerve
Radial nerve
Ulnar nerve C8, T1

Special Elbow Tests

Varus test: Tests for ligamentous stability of the lateral collateral ligament

Valgus test: Tests the medial collateral ligament

Cozen’s test: (Lateral Epicondylitis / Tennis elbow test) Patient makes fist and pronates the forearm radially deviates and extends the wrist against resistance. Positive if pain in the lateral epicondyle area.

Golfer’s elbow test: While palpating the medial epicondyle, the forearm is supinated and the elbow and wrist are extended. Positive if pain over the medial epicondyle.

Tinel’s of the elbow: Percussion of the ulnar nerve in the grove. Positive if radiating sensation down arm into hand.

Also see shoulderdoc.co.uk for other examples of shoulder PEs