Checklist

WIPER

• Patient standing in shorts or underwear with shoulder girdle exposed (bra to remain on in women).

• Expose upper limb and cervical spine.

Physiological parameters

• Observe for spinal lordosis, kyphosis or scoliosis.

Look

• Skin: erythema, scars, sinuses, symmetry of skin creases or skin elevation from underlying fracture

• Soft tissues:

• joint and soft tissue swelling

• wasting of deltoid, biceps, supraspinatus and infraspinatus muscles

• Bone: prominence of acromion, clavicular asymmetry or deformity

Feel

• Skin: temperature, tenderness, sensation

• Soft tissues:

• muscle mass: trapezius, deltoid, triceps, biceps and biceps tendon

• ligaments: coracoclavicular ligaments

• radial and ulnar pulses, capillary refill time

• sensation in ‘regimental badge' area (axillary nerve) and in hand

• Bone:

• sternoclavicular joint

• clavicle: deformity or malunion

• acromioclavicular joint

• coracoid process

• spine and borders of the scapula

• greater tuberosity of humerus

• margins of glenoid cavity

• cervical spine

Move

• Active and passive:

• flexion/extension

• internal/external rotation

• abduction/adduction

• Resisted:

• deltoid

• serratus anterior (winging of the scapula)

• pectoralis major

• trapezius

Special tests (* = essential tests)

• Acromioclavicular test*

• Impingement test*

• Instability and apprehension test*

• Rotator cuff test*

• Biceps tendon test

• SLAP test

• Thoracic outlet syndrome tests

To complete the examination…

• Examine the joint above (cervical spine: up to 30% of shoulder pain is referred from the cervical region) and the joint below (elbow).

• Check full neurovascular status of the upper limb.

• Order appropriate radiographs and further imaging.