The examiner must support the arm of the patient at the level of the elbow so that the upper extremity can be as much relaxed as possible. Then the examiner has to internally rotate the shoulder while at the same time perform a cross-body adduction of the arm. The test is positive if pain is elicited. Three physical tests used to identify a rotator cuff injury include the drop arm test, empty can test, and Neer test. A more invasive test is known as the pain-relief test. In this, an orthopedic specialist injects lidocaine into the shoulder joint.Mar
Physical Examination of Shoulder
Follows the IP-PASS examination methodology
-
- Inspection
- Palpation
- Passive Range of Motion
- Active Range of Motion
- Strength & Neurovascular
- Special Tests
Inspection
- Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
- Swelling
- Muscle tone: atrophy, hypertrophy
- Rotator cuff atrophy
- Deformity: asymmetry, rotation, amputation
- Areas of emphasis for shoulder exam
- Scapular winging?
Palpation
- Palpate for
- Effusion
- Clicking
- Snapping
- Crepitus
- Tenderness
- Temperature
- Masses
- Areas of Emphasis
- Acromioclavicular Joint
- Sternoclavicular Joint
- Coracoid Process and proximal Biceps Brachii
- Insertion of Rotator Cuff (greater tuberosity)
- Trapezius
Range of Motion
- Shoulder
- Abduction: 180 degrees
- Adduction: 50 degrees
- Forward flexion: 180 degrees
- Extension: 50 degrees
- External Rotation: 90 degrees
- Internal rotation: 90 degrees
- Elbow
- Flexion: 150-160
- Extension: 0
Strength
- Abduction:
- 0-90: Deltoid, Supraspinatus, Coracobrachialis
- 90-180: Trapezius, Serratus Anterior
- Adduction: Pectoralis Major, Latissimus Dorsi, Teres Major, Subscapularis
- Flexion: Pectoralis Major, Deltoid, Coracobrachialis
- Extension: Latissimus Dorsi
- External Rotation: Deltoid. Infraspinatus, Teres Minor
- Internal rotation: Deltoid, Teres Major, Subscapularis, Pectoralis Major, Latissimus Dorsi
Neurovascular
- Motor Nerves:
- Axillary Nerve: Abduction, External rotation, Shoulder flexion, and extension
- Musculocutaneous Nerve: Shoulder flexion
- Sensory Nerves
- Needs to be updated
- Dermatomes: C5-T1
- Deltoid (C5)
- Thumb (C6, median n)
- Posterior 1st webspace (C6, radial n)
- Middle finger (C7, median n)
- Little finger (C8, ulnar n)
- Proximal medial forearm (T1)
- Deep Tendon Reflexes (C5-C7)
- Biceps (C5, C6)
- Brachioradialis (C6)
- Triceps (C7)
- Myotomes: C5-T1
- C5: shoulder abduction
- C6: Elbow flexion Wrist extension
- C7: Elbow extension
- C8: Finger flexion
- T1: Finger abduction
- Vascular
- Radial pulse
- Ulnar pulse
Special Tests
- Subacromial Impingement Syndrome
- Neers Test
- Hawkins Test
- Jobes Test
- Painful Arc Test
- Yocums Test
- Rotator Cuff Disease: Subscapularis
- Lift Off Test
- Belly Press Test
- Internal Rotation Lag Sign
- Bear Hug Test
- Resisted Internal Rotation Test
- Rotator Cuff Disease: Supraspinatus
- Drop Arm Test
- Jobes Test
- Painful Arc Test
- Empty Can Test
- Full Can Test
- Rotator Cuff Disease: Infraspinatus/ Teres Minor
- External Rotation Lag Sign
- Hornblowers Sign (Patte Sign]
- Resisted External Rotation Test
- Proximal Biceps Tendon Injuries
- Speeds Test
- Yergasons Test
- Passive Biceps Subluxation Test
- Uppercut Test
- Ludington Test
- AC Joint Disease (Sprain, Arthritis, etc)
- Crossover Test
- Obriens Test
- Resisted AC Joint Extension Test
- One Finger Test
- Glenoid Labrum (see: Shoulder instability, Biceps)
- Shoulder Instability (General)
- Internal Rotation Resistance Test
- Crank Test
- OBriens Test
- Passive Compression Test
- Dynamic Labral Shear Test
- Anterior Instability/ Laxity
- Apprehension Test
- Jobe Relocation Test
- Load and Shift Test
- Anterior Shoulder Drawer Test
- Shoulder Fulcrum Test
- Anterior Release Test
- Posterior Instability/ Laxity
- Kim Test
- Jerk Test
- Posterior Apprehension Test
- Posterior Shoulder Drawer Test
- Inferior laxity Instability/ Laxity
- Sulcus Sign
- Gagey Test
- Multidirectional Instability
- Sulcus Sign
- Load and Shift Test
- Thoracic Outlet Syndrome
- Wrights Test
- Glenohumeral Arthritis
- Passive Compression Test
- Scapular Dyskinesis
- Scapular Assistance Test
- Scapular Retraction Test
- Lateral Scapular Slide Test
- Isometric Pinch Test
- Suprascapular Nerve Injury
- Drop Arm Test
- Jobes Test
- Winged Scapula
- Scapular Assistance Test
Dr. Md. Harun Ar Rashid, MPH, MD, PhD, is a highly respected medical specialist celebrated for his exceptional clinical expertise and unwavering commitment to patient care. With advanced qualifications including MPH, MD, and PhD, he integrates cutting-edge research with a compassionate approach to medicine, ensuring that every patient receives personalized and effective treatment. His extensive training and hands-on experience enable him to diagnose complex conditions accurately and develop innovative treatment strategies tailored to individual needs. In addition to his clinical practice, Dr. Harun Ar Rashid is dedicated to medical education and research, writing and inventory creative thinking, innovative idea, critical care managementing make in his community to outreach, often participating in initiatives that promote health awareness and advance medical knowledge. His career is a testament to the high standards represented by his credentials, and he continues to contribute significantly to his field, driving improvements in both patient outcomes and healthcare practices.
