1

Physical exam of the shoulder

IOC Advanced Team Physician

Course

Björn Engström, M.D., Ph.D., Associate Professor

Case

Male 66 y

Falling in a racerboat riding in high

waves. Due to a lot of pain in his

shoulder – He faints.

He could not move his arm.

The right shoulder was dislocated.

Dislocated Right Shoulder

Reduction of Anterior

Dislocated Shoulder

Stimson’s technique

Physical examination

History of the injury and Physicalexamination is crucial for the diagnosis

Use your knowledge in anatomy and sport

specific injury pattern

Make a preliminary state before any further

radiological, or surgical investigations i.e. there are radiological and surgical findings

without clinical relevance

2

Physical examination

Instability – Hyperlaxity – Direction

Range of Motion – Passive – Active

Pain – Localisation – Position

Muscle function – Weakness –

Coordination (thoracal-scapular rhythm)

Physical examination

Make a judgement taking all theseinformation into consideration

As the physical examination tests are

not 100% sensitive nor 100% specific –the combination of positive and

negative issues � help you to make a

good judgement

If things looks strange � Try to think

outside your ”convenient box”

ShoulderStability Tests

Apprehension test

Anterior Instability

Instability?Discomfort

PosteroSuperior

impingement?

Posterior Pain

Anterior

Instabilitymakes

throwingimpossible

(Jobe) Relocation test

Anterior Instability

3

Trauma to the

Posterior Capsule

Posterior

Instability

Posterior instability

Jerk test (in 90°and 120°). Pain-Labrum tear?

Pos Jerk test (in 120°) Load and Shift

test

Especially in a hyperlax

shoulder, you get an idéa of the magnitude of

laxity in different

directions

Sulcus sign

Inferior laxity

Capsule laxity?

General Joint Laxity

Hyperextension

Elbow > 10 gr

Knee > 10 gr

Fingers parallel to the forearm

Ankle hyperextension

Hyperopposition

The thumb leaning against the forearm

Carter & Wilkinson JBJS, 1964

4

General joint laxity

General joint

laxity

General joint laxity

Right shoulder dislocated

After “reduction”

The progress of the rehabilitation was not to good ----- very slow and the

shoulder was weak.

A lot of pain.

Case

5

What to do?

Case

MRI

orUltraSound

The ShoulderSubacromial pain

Impingement

Subacromial impingement

6

Subacromial anatomy

• Rotator cuff• Bursa

• Acromion/AC-led

• Coracoacromiala lig

MRI showing a RC tear

(Supraspinatus)

Painful arc

Hawkin test

Impingement?

Impingement injection test (=Neer test)

Impingement?The pain disappear

Jobe test

Impingement?

Pain

Supraspinatusrupture?

Weak

7

•Superior

•Labrum

•Anterior to…

•PosteriorSpeed test

(Palm-up test)

SLAP?

O’Brien test

SLAP?

Crank test

Cross-body test

AC-joint?

Impingement?

Subcoracoid

impingement?

The ShoulderImpingement due to

primary imbalance

Changing of the range of

motion pattern??

8

Instability and Impingement

S. Burkhart –A Cowboys

Guide….

The Shoulder

Muscular tests

The deep stabilisator muscles–

“Rotator Cuff”

Subscapularis(Int rotator)

Supraspinatus (Abductor)

Infraspinatus(Ext rotator)

Teres Minor (Ext rotator) Abduction test

Supraspinatus?

Jobe test

Impingement?

Pain

Supraspinatusrupture?

Weak

Lift-off test

Subscapularis?

9

Subscapularis?

Napoleon test

External rotation test

Infraspinatus?

Thoracoscapular stability

Take home message

Learn the specific anatomy and howphysical tests are stressing different

structures –

This is more important than the name of different tests!

Thank you for your kind attention!