The Shoulder - Examination Techniques

Shoulder pain is one of the most common musculoskeletal complaints. It may be due to problems intrinsic to the shoulder (85% of the time) or due to referred pain (most commonly from the neck). Causes vary by age of the patient.

Inspection:

Inspection of the shoulder should occur without obstructing clothing. Inspect anteriorly, comparing the contour of the shoulder from left to right. Note any bony deformities, joint abnormalities, or atrophy of muscles. People who have separated their acromioclavicular joint in the past may have an unusually large joint on that side, and those with a history of clavicular fracture may have a visible clavicular deformity. Posteriorly, inspect the scapulae and related muscles. Scoliosis may cause a visible shoulder elevation or scapular change from one side to the other.

Palpation:

Before palpation of the shoulder, identify the bony landmarks that will help guide your examination. Palpate systematically to ensure you cover all the bony and muscular elements. If the patient is complaining of shoulder pain, palpate the painful area lightly.

Range of Motion:

The shoulder moves in flexion, extension, abduction, adduction, internal and external rotation. To evaluate range of motion, the examiner should be standing in front of the patient, demonstrating the maneuvers for the patient. Movements should be smooth. If the patient complains of pain, selective evaluation of the individual joints or muscle groups may be necessary, but are not covered in detail in this module. Evaluate strength by asking the patient to resist movement in all directions evaluated during range of motion testing.

Click on the video icon to view a demonstration of the shoulder exam.