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18 - Examination of the shoulder

from Section 5 - Orthopaedic surgery

Published online by Cambridge University Press:  05 July 2015

James Pegrum
Affiliation:
University of London Sports & Exercise Department, London, UK
Petrut Gogalniceanu
Affiliation:
London Postgraduate School of Surgery, London, UK
Chris Lavy
Affiliation:
University of Oxford, Oxford, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

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.

Examination notes

What do you look for during initial observations?

  1. • Assess the skin quality and contours of the shoulder girdle, clavicle and scapula.

  2. • The soft tissues mass and muscle bulk are evaluated for evidence of muscle loss from disuse atrophy, found around the scapular from rotator cuff atrophy or pectoral muscles anteriorly. Deltoid muscle atrophy can also be found in axillary nerve injury.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 140 - 151
Publisher: Cambridge University Press
Print publication year: 2015

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