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Shoulder Examination

A 14-step examination covering inspection, palpation, range of motion, power and special tests.

Musculoskeletal · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Consent

    Obtain consent

  5. Ask about pain

    Ask if patient has pain in either shoulder

Step 2. Inspection (Look)

  1. Exposure and stance

    Expose/remove shirt; inspect in stance

  2. Shoulders and shoulder girdle

    Shoulders and shoulder girdle anteriorly, laterally and posteriorly

  3. Scars

    Scars

  4. Swelling

    Swelling

  5. Muscle atrophy

    Muscle atrophy (esp. deltoid)

  6. Other visible features

    Skin changes, torticollis, muscle wasting, spasms, deformity

  7. Posture and symmetry

    Posture and symmetry

  8. Report findings

    Report findings correctly

Step 3. Palpation (Feel)

  1. Instructions and position

    Clear instructions; correct patient position

  2. Temperature

    Assess temperature

  3. Bony landmarks

    Bony landmarks: sternoclavicular joint, body of clavicle, AC joint, acromion, greater tubercle of humerus, spine of scapula, bicipital groove, coracoid process

  4. Muscle bulk

    Muscle bulk

  5. Tendons and ligaments

    Tendons and ligaments

  6. Commentary

    Commentary to examiner while palpating landmarks

  7. Tenderness

    Ask about tenderness

  8. Bilateral assessment

    Assess bilaterally

  9. Report findings

    Report findings correctly

Step 4. Move – Active ROM

  1. Instructions

    Clear instructions to patient

  2. Screen

    Screen: hands clasped behind head, elbows back "against the wall" parallel to coronal plane

  3. Starting position

    Start with arm at side (0°)

  4. Flexion and extension

    Flexion and extension

  5. Abduction and adduction

    Abduction and adduction (examine abduction arc posteriorly)

  6. Internal and external rotation

    Internal and external rotation (adducted OR at 90° abduction)

  7. Symmetry, range and pain

    Note symmetry and range; ask about pain

  8. Scapular winging

    Assess scapular winging

  9. Report findings

    Report findings correctly

Step 5. Move – Passive ROM

  1. Instructions and position

    Clear instructions; patient positioned appropriately

  2. Flexion and extension

    Flexion and extension

  3. Abduction and adduction

    Abduction and adduction

  4. Internal and external rotation

    Internal and external rotation

  5. Crepitus

    Feel for crepitus

  6. Symmetry, range and tenderness

    Note symmetry and range; ask about tenderness

  7. Report findings

    Report findings correctly

Step 6. Abduction Power – Supraspinatus (Jobe's/Empty Can Test)

  1. Technique

    Appropriate technique

  2. Bilateral assessment

    Bilateral assessment

  3. Report findings

    Report findings correctly

Step 7. Power – External Rotation

  1. Technique

    Appropriate technique

  2. Bilateral assessment

    Bilateral assessment

  3. Report findings

    Report findings correctly

Step 8. Power – Internal Rotation (Gerber's/Lift-off Test)

  1. Technique

    Appropriate technique

  2. Compare sides

    Assess one side at a time and compare

  3. Report findings

    Report findings correctly

Step 9. Neer's Sign

  1. Technique

    Appropriate technique

  2. Compare sides

    Assess one side at a time and compare

  3. Report findings

    Report findings correctly

Step 10. Hawkins-Kennedy Test

  1. Technique

    Appropriate technique

  2. Compare sides

    Assess one side at a time and compare

  3. Report findings

    Report findings correctly

Step 11. Speed's Test

  1. Technique

    Appropriate technique

  2. Compare sides

    Assess one side at a time and compare

  3. Report findings

    Report findings correctly

Step 12. Yergason's Test

  1. Technique

    Appropriate technique

  2. Bilateral assessment

    Bilateral assessment

  3. Report findings

    Report findings correctly

Step 13. Apprehension and Relocation Tests

  1. Previous dislocation

    Ask about previous dislocation of either shoulder

  2. Sulcus sign

    Sulcus sign

  3. Apprehension and relocation technique

    Appropriate technique for apprehension and relocation tests

  4. Compare sides

    Assess one side at a time and compare

  5. Report findings

    Report findings correctly

Step 14. Conclusion

  1. Thank the patient

    Thank patient and indicate they may redress

  2. Further examination

    Indicate further examination of neck and elbow to complete examination

  3. Hand hygiene

    Hand wash/rub

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