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10-minute examination of the...shoulder

10-minute examination of the...shoulder

Dr Steve Brown gives a quick tour of the joint

Things to remember

• Remember that shoulder pain can be

referred from the neck, apex of lung or

gallbladder – take a careful history

• Remember the different shoulder

structures – the acromioclavicular joint (AC joint), the shoulder capsule, the

subacromial bursa and the different tendons that make up the rotator cuff

Where's the pain?

• Most patients with shoulder pain point to the upper part of the deltoid; generally

getting the patient to point to the exact site of the pain does not help with diagnosis

• See if the exact pain is reproduced by neck flexion, extension, lateral or side

flexion

• If a patient points to the area above the clavicle think of the AC joint or the neck

• For AC joint pain there may well be

tenderness on palpation of the AC joint

itself (compare with other shoulder), a

terminal arc (for example 150-180 degrees of active elevation), and pain on resisted

adduction (with the patient's arm straight and vertical get them to pull towards their side against you)

• Check joint range of movement and attempt diagnosis

• If a patient has full external rotation they are unlikey to have a frozen shoulder

• Frozen shoulder patients tend to have good muscle strength on individual muscle testing, but restriction on external rotation and abduction

• Learn what the different muscles do: supraspinatus abduction, infraspinatus

external rotation, subscapularis internal

rotation, biceps elbow flexion

• If a tendon is torn there will be complete weakness and no pain (also the case with a nerve problem), if a tendon is partially torn there will be a degree of weakness and pain

Best reference

www.gp-training.net/rheum/exam

Steve Brown is a GP trainer in Beaconsfield, Buckinghamshire

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