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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

SPORTS MEDICINE SYMPOSIUM

Examination of the Shoulder

University of Texas HealthScience Center San Antonio

TexasDaniel Robertson, MD

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

REMEMBER THE BASICS

• Age of patient

• What is chief complaint ??

• Was there an injury?? – How? When? Where?

• Careful history and review of systems and good physical exam will lead to the correct diagnosis

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

There is lots of anatomy on the top and front of the shoulder—here is the impingement area !!

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

The A/C joint

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

The lesser tuberosity at insertion of subscapularis

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Pain at greater tuberosity at site of rotator cuff

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

The long head of the Biceps tendon

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Components of a good Physical exam:

• Look the patient over and compare both shoulders

• Range of motion

• Muscle testing

• Stability testing

• Special tests

• Vascular exam

• Neurological exam

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Physical Exam

I. Look the patient over • Look at both shoulders

• Feel and compare both shoulders

• Move both shoulders

• Deformities, swelling, color, etc

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

BAD EXAM !!!

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

BETTER--BUT STILL A BAD EXAM !

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

A GOOD EXAM OF SHOULDERS

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Look for old scars??

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Big scars??

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Comparison of shoulders

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Palpation

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Deformity ?

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Tenderness

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Physical ExamII. Range of motion

- compare to normal shoulder

- active and passive ROM

- careful measurements with

goniometer

III. Muscle testing- grade strength 0 - 5

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Exam both shoulders

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Active flexion –with goniometer

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Passive flexion

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Comparison of internal rotation

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Active external rotation

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Measurement of rotation with a goniometer

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Active internal rotation

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Internal rotation with the tip of thumb at T 6 spinous process

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Active extension

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Strength of rotator cuff

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Empty Can

Supraspinatus

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Speed’s

Bicep Tendon Pathology

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

O’Brians

Labral Pathology

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Resisted External Rotation

Infraspinatus

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Lift Off Test

Subscapularis

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Physical Exam

IV. Stability Testing

- Anterior and posterior stability of the glenohumeral joint

- Relocation test

-General Laxity??

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Stabilize the scapula and then test stability

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Anterior GH instability

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Posterior instability

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Testing stability with Relocation test

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Is there any hand or finger laxity and instability??

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Hyper extension of elbows

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Finger hyperextension indicates generalized ligament laxity of all of the joints.

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Physical Exam

V. Special Shoulder Tests- Impingement or NEER test

- Hawkins test

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Impingement test—is there pain on anterior acromion??

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Positive NEER Impingement sign

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Positive Hawkings test

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Physical Exam

VI. Vascular Examination- ROOS’s for thoracic outlet- Distal pulses

VII. Neurological Examination-Motor and sensation of the radial. ,median., ulnar musculocutaneous and axillary nerves.

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Do not forget to evaluate the cervical spine ! !

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Skin sensation

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

Distal pulses

THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

ROOS test for cervical rib

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THE SHOULDER SVC DEPT OF THE U.T HEALTH SCIENCE CENTER @ SAN ANTONIO

IN SUMMARY---- A CAREFUL HISTORY AND A GOOD PHYSICAL EXAM WILL LEAD YOU TO THE CORRECT DIAGNOSIS IN 95% OF CASES----FOR THE OTHER 5% YOU WILL NEED PROPER X-RAY EVALUATIONS