Physical Examination for Shoulder Pain

The shoulder complex is in fact quite difficult to assess due to its many structures that are located in a small area, its many movements, and the many lesions that could occur either inside or outside the joints. A thorough physical examination ensures that key aspects of the condition are obtained and important conditions are not missed.

Information gathered by physically examining the injured shoulder helps guide decisions about the various shoulder tests or investigations needed and ongoing management of the condition. Most of the commonly seen shoulder conditions initially present with such similar symptoms or signs, and so the various shoulder tests done physically can go a long way in arriving at a conclusive diagnosis.

The various physical examination maneuvers developed to assist doctors in diagnosing shoulder problems, helps to accurately understand the problem and is paramount to a proper shoulder examination. During physical examination, the front and the back of the shoulder is checked. Signs like bulk and scapular positioning can be easily observed in this way. The shoulder specialist will check the posture in both the seated and standing positions and from different angles. Scars, atrophy, swelling, ecchymosis, erythema, rashes, deformities, shoulder heights, and scapular positioning are all aspects that can be further evaluated.

Thorough examination of shoulder symptoms should ideally include the cervical spine, contralateral shoulder, elbow, trunk, and upper-limb neurovascular structures. Performing a musculoskeletal examination is especially important in the case of shoulder related problems. The key to performing a good shoulder examination is to develop a system where the shoulders can be seen, where both sides are compared, where a neurovascular examination is done and when the cervical spine joint is also considered in the process.

There is a certain skill and ability that the physical examination of the shoulder calls for. Physical examination by a specialist will include inspection, palpation, shoulder movement evaluation, strength, stability, and provocative maneuvers. Range of motion is also an important component of physical examination of the shoulder.

When performed bilaterally the doctor can observe side-to-side differences. Some basic things can be determined by checking the range of motion, like pain between 60º and 120º arm abduction could mean Shoulder Impingement Syndrome or if there is pain over 120º arm abduction, this could mean an issue with the AC joint source and so on. Proper examination can also help to identify anatomical alterations like atrophy, AC joint deformity, nerve palsy or traumatism. In older people, severe atrophy on supraspinatus or infraspinatus muscles could mean rotator cuff tears, protraction of the scapula may denote a neurological lesion showing a winged scapula on examination.

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