Shoulder and Elbow Assessment
Sarah Rayner ESP Physiotherapist
Dr Tim Hughes GPSI
MSK Orthopaedic Services
History
Inspection,
palpation
Physical
tests
Make diagnosis &
inform management
History
Consider at baseline: age, general health and co-morbidities, nature/mechanism of onset
(trauma?), pain distribution, pain behaviour (e.g. night pain, inability to lie on affected side,
dead arm syndrome, catching), aggravating/easing (e.g. overhead activities), stiffness,
weakness, paraesthesia, joint sounds, functional impairments and previous treatments.
Frozen shoulder
SLAP lesion
Anterior dislocation
Primary GHJ osteoarthritis
Bursitis
Multidirectional instability
Secondary GHJ osteoarthritis
Tendinosis
Posterior dislocation
ACJ osteoarthritis
Rotator cuff tear
Fracture
SCJ osteoarthritis
Spinal accessory neuritis
ACJ injury
Joint laxity
Suprascapular neuritis
Neoplasm
Subacromial impingement
Long thoracic neuritis
Referred pain from neck
Internal impingement
Parsonage-Turner syndrome
Referred pain from viscera
Anterior instability
History
Consider at baseline: age, general health and co-morbidities, nature/mechanism of onset
(trauma?), pain distribution, pain behaviour (e.g. night pain, inability to lie on affected side,
dead arm syndrome, catching), aggravating/easing (e.g. overhead activities), stiffness,
weakness, paraesthesia, joint sounds, functional impairments and previous treatments.
Frozen shoulder
Recurrence likelier in younger individuals;
often causes cuff tears in
primary injury
the older
SLAP lesion
Anterior dislocation
Primary GHJ osteoarthritis
Bursitis
Multidirectional instability
Secondary GHJ osteoarthritis
Tendinosis
Posterior dislocation
ACJ osteoarthritis
Rotator cuff tear
Fracture
SCJ osteoarthritis
Spinal accessory neuritis
ACJ injury
Joint laxity
Suprascapular neuritis
Neoplasm
Subacromial impingement
Long thoracic neuritis
Referred pain from neck
Internal impingement
Parsonage-Turner syndrome
Referred pain from viscera
Anterior instability
Shoulder: Common conditions
• Impingement
• Rotator Cuff tears
• Frozen shoulder
• AC joint pain
Shoulder Assessment
Standard tests
Observations
•
Deformity, wasting, heat, effusion,
winging, bony contours
Active movements
•
•
•
Neck x 6 (flex, ext, side flex and rot)
Shoulder girdle elevation (SCJ, ACJ)
Shoulder elevation (plus passive
over-pressure)
o Does the movement look “right”?
o Is active range full? If not:
o Is the joint stiff?
o If the joint isn’t stiff, lost range may be
due to weakness or pain.
•
o Painful arc? (impingement)
Apley scratch test: hand down neck
& hand up back (evaluate function)
Passive movements
•
Lateral rotation* (capsular pattern)
Isometric actions
Resisted tests
•
•
•
•
Abduction
Adduction
Lateral Rotation
Medial Rotation
Rotator cuff tests
•
•
•
•
Full can test (supraspinatus)
Drop sign (Massive RC tear)
ER lag sign (supraspinatus)
Lift off test /Belly press(subscapularis)
Accessory tests (as required)
•
•
Scalf Test (ACJ)
Neer, Hawkins and Kennedy
(impingement)
Palpation for tenderness
•
As required
* Restriction = summary of Cyriax’s “capsular pattern”
Elbow Assessment
Standard tests
Observations
•
Deformity, wasting, heat, effusion,
bony contours
Active movements
•
•
•
•
Neck x 6 (flex, ext, side flex and rot)
Shoulder (elevation, HBB, LR)
Elbow: flex/ext,
pronation/supination
Wrist: flex/ext, RD/UD
o Is active range full? If not:
o Is the joint stiff?
o If the joint isn’t stiff, lost range may be
due to weakness or pain.
Passive movements
•
End feel, crepitus, pain
Isometric actions
Screening tests
• Extension
• Flexion
Passive stretching
• Combined elbow ext, wrist flex and
pronation (stretches extensors)
• Combined elbow ext, wrist ext and
supination (stretches flexors)
Accessory tests (as required)
Palpation for tenderness
• As required