In the name of GOD
Sheikhlotfolah
mosque
Shoulder &Upper arm
Physical Examination
Babak Vahdatpour MD
Assistant professor
Department of Physical Medicine & Rehab.
Isfahan University of Medical Sciences
DDx. of Shoulder Pain or reduced
R.O.M
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Rotator Cuff Dis.
Adhesive Capsulitis
Calcific Tendonitis
Dynamic Functional Instability
A.C Degenerative Joint Dis.
Glenohumeral Degenerative Joint Dis.
Arthropathy(crystalline & Rheumatoid)
Cervical Radiculopathy
Tumors(shoulder girdle & lung apex)
Physical Examination
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inspection
palpation
range of motion
strength
provocative shoulder test
neck & elbow
Inspection
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both shoulders exposed
inspection of both shoulders
swelling
asymmetry
muscle atrophy
scars
ecchymosis
venous distension
Inspection
• squaring of the shoulder
→ anterior dislocation
Swollen subacromial bursa in R.A
Rupture of the left pectoralis major tendon.
Inspection
Fractured left clavicle.
Swollen sternoclavicular joint due to a fracture
of the medial end of the left clavicle
• scapular "winging"
→ shoulder instability
serratus anterior dysfunction
trapezius dysfunction
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Rupture of the long head
of the biceps tendon (arrow).
Inspection
• atrophy of the supraspinatus or infraspinatus
→ rotator cuff tear
suprascapular nerve entrapment
neuropathy
Palpation
• tenderness
• deformity
1.subacromial space
→ rotator cuff tendinitis
impingement syndrome
calcific tendinitis
rotator cuff tear
2.bicipital groove
→ bicipital tendinitis
bicipital tendon subluxation, tear
3.acromioclavicular joint
4.anterior glenohumeral joint
→ glenohumoral arthritis
osteonecrosis
glenoid labrum tear
adhesive capsulitis
5.sternoclavicular joint
6.posterior edge of acromion
→ rotator cuff tendinitis
calcific tendinitis
rotator cuff tear
7.suprascapular notch
→ suprascapular nerve entrapment
8.Quadrilateral space
→ axillary nerve entrapment
Range of Motion testing
• compared with the unaffected side
• active & passive
: loss of active motion alone
→ weakness of muscle than joint ds
: LOM with both active & passive Ex
→ arthropathies
adhesive capsulitis
Range of Motion testing
• Flextion & Extension
• Abduction & Adduction (scapulohumeral
rhythm)
• Internal rotation & External rotation
• Scapular Retraction & Protraction
Apley scratch test
Painful arc of abduction.
Passive shoulder abduction
Shrugging of the scapula to increase abduction (right shoulder)
Measurement of rotation in 90° abduction.
A, Neutral position. B, External rotation.
C, Internal rotation.
Muscle testing
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Scapular stabilizers
Rotator cuff
Humeral Adductor/Internal Rotators
Humeral Abductors
Elbow Flexors & Extensors
Scapular stabilizers
– Serratus ant.
– Rhomboids
– Trapezius
Evaluating the Rotator cuff
• supraspinatus
infraspinatus
teres minor
subscapularis
• pain
• weakness
Supraspinatus
• "empty can" test (Jobe test)
FIGURE 3. Supraspinatus examination
("empty can" test). The patient attempts to
elevate the arms against resistance while
the elbows are extended, the arms are
abducted and the thumbs are pointing
downward.
Infraspinatus and Teres minor
FIGURE 4. Infraspinatus/teres minor
examination. The patient attempts to
externally rotate the arms against
resistance while the arms are at the sides
and the elbows are flexed to 90 degrees
Subscapularis & other int. rotators
Humeral Adductor/Internal Rotators
• Pecturalis Major
• Latissimus Dorsi
Humeral Abductors
• Deltoid
• Supraspinatous
Elbow Flexors & Extensors
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Biceps
Brachialis
Brachioradialis
Triceps
Provocative test
Neer's test(sign)
• subacromial
impingement
• impingement test
: injection
FIGURE 5. Neer's test for impingement of the rotator
cuff tendons under the coracoacromial arch. The arm is
fully pronated and placed in forced flexion.
Hawkin's test
• subacromial
impingement
• rotator cuff
tendonitis
FIGURE 6. Hawkins' test for subacromial impingement or
rotator cuff tendonitis. The arm is forward elevated to 90
degrees, then forcibly internally rotated.
Drop-arm test
• rotator cuff tear
• supraspinatus dysfunction
O`Brien test
A.C joint or labrum injury
Cross-chest test
• acromioclavicular
joint dysfunction
FIGURE 7. Cross-arm test for acromioclavicular
joint disorder. The patient elevates the affected
arm to 90 degrees, then actively adducts it.
Ant. Apprehension
• ant. instability
FIGURE 8. Apprehension test for anterior instability. The
patient's arm is abducted to 90 degrees while the examiner
externally rotates the arm and applies anterior pressure to
the humerus.
Relocation & Release test
Jerk test & post. Apprehension test
• Post. instability
Sulcus sign
• inferior glenohumeral
instability
FIGURE 10. Sulcus test for glenohumeral instability.
Downward traction is applied to the humerus, and the
examiner watches for a depression lateral or inferior to the
acromion.
Speed's maneuver
• proximal tendon of the long head of the
biceps
Yergason test
• biceps tendon
FIGURE 9. Yergason test for biceps tendon instability or
tendonitis. The patient's elbow is flexed to 90 degrees,
and the examiner resists the patient's active attempts to
supinate the arm and flex the elbow.
Thoracic Outlet Syndrome
• Adson`s test
Thoracic Outlet Syndrome
• Roos` test
33 pole
Isfahan