Physical examination of the shoulder
- Stephen M Simons, MD, FACSM
Stephen M Simons, MD, FACSM
- South Bend Sports Medicine Fellowship
- J Bryan Dixon, MD
J Bryan Dixon, MD
- Clinical Assistant Professor of Family Medicine
- Michigan State University College of Human Medicine
- Medical Director
- United States Olympic Education Center
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
The evaluation of patients with shoulder dysfunction or pain can be difficult. Skillful examination of the shoulder is an integral part of this evaluation and is necessary to generate an appropriate differential diagnosis and to help determine whether advanced imaging is needed.
The large number of shoulder examination techniques, often named for their originators, can be confusing. In addition, although these maneuvers are often taught as if they are pathognomonic for a particular pathology, their diagnostic accuracy is often uncertain and many studies designed to assess their test characteristics (eg, sensitivity, specificity) are difficult to interpret . As an example, multiple examination maneuvers may yield positive results in a patient with an acutely injured shoulder, thereby reducing specificity.
This topic reviews the examination of the shoulder, including many special tests designed to detect particular lesions. A systematic approach to the patient with shoulder complaints and discussions of specific shoulder problems are found separately. (See "Evaluation of the patient with shoulder complaints" and "Shoulder impingement syndrome" and "Rotator cuff tendinopathy" and "Presentation and diagnosis of rotator cuff tears" and "Acromioclavicular joint disorders" and "Frozen shoulder (adhesive capsulitis)" and "Glenohumeral osteoarthritis" and "Radiologic evaluation of the painful shoulder" and "Overview of upper extremity peripheral nerve syndromes", section on 'Proximal neuropathies'.)
ANATOMY AND BIOMECHANICS
A complex network of anatomic structures endows the human shoulder with tremendous mobility. These structures and the related biomechanics are discussed separately. (See "Evaluation of the patient with shoulder complaints", section on 'Anatomy and biomechanics'.)
TIPS FOR A PRODUCTIVE EXAMINATION
The following tips may be helpful for performing the shoulder examination effectively and efficiently:
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- ANATOMY AND BIOMECHANICS
- TIPS FOR A PRODUCTIVE EXAMINATION
- NEUROVASCULAR ASSESSMENT
- RANGE OF MOTION
- Approach to shoulder motion assessment
- Active range of motion
- Passive range of motion
- EXAMINATION FOR ROTATOR CUFF PATHOLOGY
- Overview and evidence
- Assessment of abduction and the supraspinatus
- Assessment of external rotation and the infraspinatus
- Assessment of internal rotation and the subscapularis
- Testing for rotator cuff tear
- SPECIAL TESTS FOR SHOULDER IMPINGEMENT
- Passive painful arc (Neer) test
- Flexion with internal rotation (Hawkins-Kennedy) test
- SCAPULOTHORACIC MOTION AND STRENGTH
- Normal movement and approach to testing
- Special tests
- SPECIAL TESTS FOR SHOULDER INSTABILITY
- Sulcus sign
- Apprehension, relocation, and release tests
- Load and shift test
- Jerk test
- SPECIAL TESTS FOR BICEPS TENDON PATHOLOGY
- SPECIAL TESTS FOR LABRAL (SLAP) PATHOLOGY
- EXAMINATION OF THE ACROMIOCLAVICULAR JOINT
- EXAMINATION OF THE STERNOCLAVICULAR JOINT
- SUMMARY AND RECOMMENDATIONS