LHUP PA Shoulder Exam 04
Shoulder Exam
Student’s Name
__________________________________
Evaluators’ Name
____________________________________
Grading Criteria
1) The item must be performed correctly, completely, and accurately.
2) The item must be performed with regard to patient’s comfort, safety or
feelings.
3) Student, when requested by faculty, must be able to explain the technique
or the reason (DiffDx) for the exam.
4) You must tell the examiner everything you are inspecting for or you will
not receive credit.
5) You must initiate all exams and continue unless instructor tells you to
proceed to the next exam. You will NOT get credit for saying “I would
do …”
6) As a student patient you are required to appropriately attired as to enable
the examiner to correctly complete the examination with appropriate
exposure
7) The examiner may notify you immediately of a failure should you:
 Fail to adequately expose the body part being examined
 Auscultate through clothing
 Any exam performed without concern for patient safety (i.e.
palpating the abdomen before percussing, improperly using
otoscope etc)\
 Any technique that may significantly decrease the accuracy of
an exam (not auscultating the abdomen before palpation etc)
Faculty Comments:
Today’s Date: _____________________________
Evaluation
Criteria
Unsatisfactory
Satisfactory
Exceeds
Expectations
Communication
Student politely greets patient
and explains to patient
technique to be performed
History
Student acquires appropriate
detail of symptoms and
pertinent ROS,
PMH,FHX,SOCHx,Meds,Alle
rgies
N/A
Exam Technique
Student performs examinations
using a techniques that assure
accuracy
Thoroughness
Student completes greater than
90% of required examinations
Organization
Student completes the exam in
an organized fashion
Diff Diagnosis
Student aware of primary and
competing Diagnosis
Labs/Studies
Student orders cost effective,
appropriate labs and studies
and is able to interpret results
Management
Student able to state basic
management principles
including pt education,
meds/surg treatments,Health
Promotion/Disease Prevention
Strategies, Disposition and
follow up
Overall Evaluation
N/A
N/A
N/A
Neuro_Exam-Complete-04
LHUP PA Shoulder Exam 04
Shoulder Exam
Diff Dx
Stated
Test
1. deformity
2. swelling
3. atrophy
Inspect
Test
Done
N/A
States inspecting & comparing bilaterally
Stand behind pt., palpate and name:
1) Suprasternal notch & SC (sternoclavicular) joint
2) Clavical
3) Coracoid process
4) AC (acromioclavicular) joint. (bilat. using “crossover test”)
5) Acromion
1). Greater Tuberosity of the Humerus
2). Biciptal Grove (bicipital tendon)
Palpation
Differential
Considerations & Notes
1. scoliosis may cause
elevation of one
shoulder.; dislocation;
3. atrophy may be cervical
nerve lesions
1) Spine of scapula
2) Body of scapula
Rotator Cuff (SITS) (palpate general area, name muscles if you can)
1. Supraspinatus
2. Infraspinatus
3. Teres minor
(4. Subscapularis)
Subacromial & Subdeltoid bursa (passively extend shoulder post)
Axilla (clearly use a pyramidal-shaped searching style)
Major Muscles
1. Sternocleidomastoid
4. Deltoid
2. Pectoralis Major
5. Trapezius
3. Biceps
6. Rhomboid
7. Latissimus Dorsi
1. dislocation SC joint
2. fx clavical
3.
4. AC separation (crepitus,
elevated clavicle, tender),
arthritis
Bicipital Tendinitis
Fractures
Tender sprains & tears
Bursitis
lymph node enlargement
Bicep rupture
Exam Shoulder 3-11.doc
last updated 03-11, sj
LHUP PA Shoulder Exam 04
Test
Done
DiffDx
Stated
N/A
Special Tests
ROM
N/A
Sensory
Vascular
n/a
n/a
Active & Passive ROM
1. Flexion (180) & Ext (60)
2. ABduct (180) & ADduct (45)
3. External rotation (90) & Internal rotation ( 90)
Apley “scratch” test (active ROM with rotation):
1) touch opposite superior medial angle of scapula
2) touch opposite A/C joint
3) touch opposite inferior angle of scapula
“Drop-arm” sign: The examiner abducts the pt’s shoulder to 90 and then asks pt to
slowly lower it to the side in the same arc of movement. If pt. is unable to return
arm slowly or without severe pain then this is positive for rotator cuff tear.
Yergason Test
Pt flex elbow 90 and hand in pronation.
Examiner grasps base of elbow and wrist resisting pt.’s attempt tosupinate and
externally rotate the shoulder.
Bicept tendon, if unstable. will slip out causing pain.
Allen Test
Examiner locates the radial pulse, flexes pt’s elbow to 90 while shoulder is
extended horizontally and rotated laterally. The patient then rotates the head
AWAY from the test side. If the pulse disappears when patient rotates head
AWAY then it is positive for Thoracic Outlet syndrome.
Apprehension Test for chronic Shoulder Dislocation
Examiner ABducts and Ext. rotates shoulder. Pt. will look apprehensive if
positive.
The Impingement Test
The pt’s arm is forcibly elevated through forward flexion by the examiner. If pt.’s
face shows pain, this is positive. Pain is caused by “jamming” of the greater
tuberosity against the anteroinferior acromial surface.
States C5 patch over lateral arm. o/w gross exam
Rotator cuff will drop. (especially in
the supraspinatus muscle)
long head of the biceps tendon
instability
Thoracic Outlet syndrome
Chronic Shoulder dislocation
Glenohumeral Impingement.
Overuse injury of the supraspinatus muscle or biceps tendon
Checks radial pulse.
Cursory exam neck
Others
Cursory exam same side elbow
Cursory exam opposite shoulder
Exam Shoulder 3-11.doc
last updated 03-11, sj