During the examination, the patient should be exposed in such a way that the examiner can see the whole of. Remember, if you have forgotten something important, you can go back and complete this. Therapeutically, joint aspiration in the face of painful effusion relieves the patients discomfort and may facilitate a more accurate joint examination. By gaining an appreciation for the basic structures and functioning of the joint, youll be able to logic your way thru the exam, even if you cant remember the eponym attached to each specific test. Checklist for physical examination of the shoulder musculoskeletal block chris mcgrew md, andrew ashbaughdo this handout is for use as a rough guide and study aid. Examination of the shoulder joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient to expose their shoulders fully inspection look anterior, lateral, and posterior asymmetry or deformity scars or skin changes muscle bulk palpate temperature. Primary care sports medicine fellow steadman hawkins clinic of the carolinas. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuffspecific testing biceps testing. I have included detailed descriptions of the shoulder, knee, and low back examinations as these are the most commonly affected areas.
Some differences can occur due to shoulder dominance. There are a large number of tests that can be performed in the shoulder examination, many of which may check. As with the shoulder and knee examinations, there are critical steps that form the basis of the examination of the hip joint. The shoulder joint is one of the more mobile joints in the body and restriction can have a significant effect on functional ability 1, 2. The exam for shoulder pain stanford medicine 25 youtube. In each case it is important to be familiar with some basic examination tools that can help us confirm. Ppt shoulder examination powerpoint presentation free to. Wright, md this article summarizes the overall assessment of the shoulder joint and seeks to help direct.
In thin subjects the posterior labrum can be clearly seen. The key principle with this phase of the shoulder examination is symmetry. Range of joint motion evaluation chart name of patient client identification number instructions. Shoulder examination a free powerpoint ppt presentation displayed as a flash slide show on id. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration. Aug 24, 2015 do not perform any examination or procedure on patients based purely upon the content of these videos. Clinical assessment of the shoulder sta healthcare. Evaluating for meniscal injury joint line palpation.
If the patient experiences pain or is unable to perform these movements you would then proceed to perform a more detailed examination of the shoulder joint as shown in the full shoulder examination section below. Professor in residence ucsf department of orthopaedic surgery chief, sports medicine and shoulder physical examination 5 minute office exam visual inspection palpation motion cuff. Instability the common disorders arise from diseases of the following structures. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral. A focused history is the most valuable yet least effectively used tool in clinical medicine. When assessing shoulder pain, a structured physical examination. Clinical examination of the shoulder joint complex kevin e.
The etiology is most of the time traumatic and related either to sport or accidents. Shoulder examination instructions examine the shoulder joint of this patient examiner summarise your. Shoulder pain leads many patients to see a primary care physician. Palpate the sternoclavicular joint, the clavicle, the acromioclavicular joint, the acromion, the coracoid process, the head of the humerus, the greater tubercule and the spine of the scapula.
Shoulder exam stanford medicine 25 stanford medicine. The shoulder is a ball and socket joint formed from three bones the clavicle. Therefore, if one describes anterior dislocation of the shoulder joint or a frozen shoulder, they are in fact referring to the glenohumeral joint. Shoulder pain is one of the most common complaints in the outpatient setting. For each affected joint, please indicate the existing limitation of motion by drawing a lines on the figures below, showing the maximum possible range of motion or by notating the chart in degrees.
The muscles surrounding the joint undergo reflex spasm in response to pain originating in the joint, which in turn serves to immobilize the joint and thus reduce the pain. Pain, catching, or grinding in the shoulder indicates a labral tear slap lesion. How i do a 5 minute comprehensive examination of the shoulder. The examination of all joints follows the general pattern of look, feel, move as well as. Shoulder disorders are can be broadly classified into the following types. Special tests in shoulder examination examination of the shoulder should be performed after the examiner has obtained a careful and thorough history.
Acute shoulder injuries in adults are often initially managed by family physicians. If signs warrant, or if suspicion of meniscal lesions or instability arises. The practitioner pushes on the elbow, pushing the humeral head further into the joint whilst rotating the shoulder. Within the book, he provided a table to help clinicians distinguish various shoulder conditions.
Clinical examination of the shoulder girdle a shoulder examination or shoulder exam is a portion of a physical examination used to identify potential pathology involving the shoulder. This video is brought to you by the stanford medicine 25 to teach you the common causes of shoulder pain and how to diagnose them by the physical exam. Place 1 hand behind the back and push out against resistance. The shoulder examination, along with all other joint examinations, is commonly tested on in osces. Joint examination an overview sciencedirect topics. Meyers, md from orthopaedic research of virginia, richmond, virginia careful examination of the shoulder is an essential component in forming a diagnosis of problems in this area. Mainly 40 to 65 year olds frequently women pain around shoulder, occ. The glenohumeral joint is often referred to simply as the shoulder joint. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting. Youll be expected to pick up the relevant clinical signs using your examination skills. Geeky medics accepts no liability for loss of any kind incurred as a result of reliance upon. Briefly explain to the patient what the examination involves. Clinical examination of the shoulder complex martin boublik, md richard i. Whole shoulder frozen shoulder superior shoulder ac joint.
During the examination, the patient should be exposed in such a way that the examiner can see the whole of the upper body, both front and back. The necessary skills can be developed by examining colleagues or patients. The shape, position and function of each shoulder should be relatively similar. To complete exam to complete my examination i would examine the joint above and joint below, and also do a full neurovascular exam distal to. Other orthopedic history surgeries, arthritis, trauma, injuries etc physical exam. High impact rheumatology joint examination and injection techniques part 1. Your instructor may perform certain maneuvers differently than depicted here. Reinold, dpt, atc, cscs2 brian cole, md, mba3 1champion sports. Vague shoulder pain with a normal physical examination should increase. Oct 04, 2010 shoulder examination frequently appears in osces. The knee examination, along with all other joint examinations, is commonly tested on in osces. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
Nov 17, 2016 anyone who has recently had an anterior dislocation of the shoulder joint or has anterior instability will find this position uncomfortable. Clinical examination and manual therapy of the shoulder and shoulder girdle diagnose precisely. Keeping these muscles strong can relieve shoulder pain and prevent further injury. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. All osce notes and osce examinations are downloadable for medicine osce exam finals revision. Other causes are degenerative joint disease and arthritis.
Initial assessment of the injured shoulder pdf 431kb. Shoulder pain assessment for the occupational health nurse. Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Pdf physical examination of the shoulder researchgate.
How i do a 5 minute comprehensive examination of the shoulder c. Nov 28, 2012 this video produced by students at oxford university medical school in conjunction with the faculty demonstrates how to perform an orthopaedic examination of the shoulder joint. The shoulder ap view is a standard projection that makes up the two view shoulder series. In each case it is important to be familiar with some basic examination tools that can help us confirm the presence of a shoulder lesion. The arm is abducted to 90 degrees with the elbow also bent to 90. Ac joint, bicep tendon, and the greater tuberosity of the humerus supraspinatus should be included. Discussion thorough history taking including psychosocial aspects and skilled examination are essential. Testing of rotator cuff integrity should be part of all shoulder exam. Bobby masocol md primary care sports medicine fellow. The diagnosisdriven physical exam of the shoulder april 24, 2014. With shoulder injuries often whats known as scapulohumeral rhythm is affected how your shoulder blades move in relation to your arms, so your practitioner should also look for this. The examination of all joints follows the general pattern of look, feel, move and occasionally some special tests.
The diagnosisdriven physical exam of the shoulder april 24, 2014 carlin senter md, natalie voskanian md, veronica jow md. Compound movements are often used as a rapid screening tool for shoulder joint pathology as they test a number of the rotator cuff muscles in one go. In 1934, in his classic book the shoulder, codman1 was the. Internally rotate shoulder to near maximum holding the wrist by passively lifting the dorsum of the hand away from the lumbar spine then supporting the elbow, tell patient to maintain position and release the wrist while looking for a lag.
This article presents a systematic approach to diagnosing and managing disorders of the shoulder joint and surrounding structures. Dec 16, 2012 acromioclavicular joint problem may be elicited by anterior pain with motion and tenderness to palpation over the acromioclavicular joint. How i do a 5 minute comprehensive examination of the. Greater and lesser tuberosity, feel for rotator cuff defects. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Bobby masocol md primary care sports medicine fellow steadman. Acute shoulder injuries in adults american academy of. Goes to wrist reduced gh joint rom active passive capsular restriction erabdir resisted tests pain free. Pain radiates from superior shoulder to lateral neck and upper trapezius pain with reaching, especially across body pain with pushups, bench press, and overhead lifting aching rest pain usually insidious onset no change in shoulder pain with neck rom. Physical examination of the shoulder musculoskeletal key.
Clinical examination and manual therapy of the shoulder and. Check out the shoulder examination mark scheme here. Again, the injured shoulder should be compared with the uninjured shoulder figure 2. Examination may report clunking some mild instability sensations. The shoulder is often considered a difficult joint to examine, and this is partly due to the large num ber of different clinical tests of shoulder function. Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. The joint is sensitive to pain, pressure, excessive traction, and distension. The tradeoff for this freedom of motion is a relative lack of stability, which makes the. Joint aspiration offers both diagnostic and therapeutic benefits when managing joint effusion or inflammation. You should ensure you are able to perform this confidently. This hip examination contains 21 steps, which compares well with the shoulder 20 step exam and the knee 33 step exam.
Feb 22, 20 shoulder examination for orthopedic students. Diagnostically, the procedure permits acquisition of synovial fluid for analysis. During this part of the examination, remind the patient to report if they feel any pain. At the conclusion of this program, the learner will be able. Injury to the shoulder joint is followed by pain, limitation of movement, and. The projection demonstrates the shoulder in its natural anatomical position allowing for adequate radiographic examination of the entire clavicle and scapula, as well as the glenohumeral, acromioclavicular and sternoclavicular joints of the shoulder girdle. It is the role of primary care, orthopaedic and rheumatological clinicians to assess complaints relating to the shoulder in a systematic manner. The likely diagnosis will have been derived from the history. This part of the assessment involves the practitioner looking at the shoulder itself, examining it and the joints above and below elbow and neckupper back. Move the transducer medial to the labrum on transverse plane to visualize the spinoglenoid notch. Shoulder examination osce guide old version youtube. The ottawa knee rules a useful clinical decision tool.
509 822 270 1373 724 1405 1065 1211 926 431 903 1045 868 44 1476 92 1627 1169 1266 575 847 1354 1005 792 1543 886 942 472 1203 384 615 1392 1240 278 4 226 645