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Shoulder examination

Follow the scheme below:

  • Inspection
  • Palpation  
  • Movement

Before starting

  • Introduce yourself
  • Explain what the examination entails
  • Ask permission to perform examination
  • Expose the patient appropriately - from the waist above exposing both the upper limbs, but leaving the underwear on
  • Preserve dignity bu using a blanket appropriately 
  • Tell the patient to let you know if anything you do is uncomfortable
  • Remember - always watch the patients face 

Inspection

General observation

  • Does the patient look well?
  • Does the patient suffer from any obvious medical conditions? 
  • Hands (Rheumatoid arthritis?)

Patient Standing

Remember to inspect from the front, side and above:

  • Skin
    • Scars
    • Bruising
    • Skin changes
    • Sinuses
    • Inflammation
  • Asymmetry - supraclavicular fossa
  • Muscle wasting
    • Especially of the deltoid (disuse or axillary nerve palsy)
    • Periscapular muscles (supraspinatus and infraspinatus) 
  • Deformity
    • Sternoclavicular (SCJ) (prominent - subluxation)
    • Acromioclavicular (ACJ) joint (prominent - subluxation or osteoarthritis)
    • Clavicle (old fractures) 
    • Shoulder dislocation
    • Popeye muscle (rupture of proximal portion of long head of biceps)
  • Swelling of the joint
  • Axilla 

From behind, look for:

  • Rotator cuff wasting
  • Scapula normmaly shaped and situated (Sprengel's shoulder, Klippel-Feil syndrome)
  • Webbing of the skin at the root of the neck (Klippel-Feil syndrome)
  • Winging of the scapula (paralysis of the serratus anterior muscle due to long thoracic nerve palsy)

Palpation



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