A Shoulder examination (or shoulder exam) is a portion of a physical examination used to identify potential pathology involving the shoulder. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting.
InspectionPalpation of sternoclavicular joint, clavicle, acromioclavicular joint, subacromial bursa, bicipital tendon.Evaluation of passive and active range of motion: Neck range of motion should be assessed that may reveal a neck source of shoulder pain. The Apley scratch test specifically tests range of motion and in a normal exam, an individual should be able to reach C7 on external rotation, and T7 on internal rotation.Evaluation of distal pulsesStrength testing: wrist extension tests the radial nerve, finger abduction tests the ulnar nerve, and thumb apposition tests the median nerve.Sensation testingReflex testing: Triceps reflex tests C6-C8, biceps reflex tests C5 and C6, and brachioradialis reflex tests C5-C7.Provocative maneuversNeer impingement sign: a positive test indicates shoulder impingementHawkins-Kennedy test: a positive test indicates shoulder impingementEmpty beer can test: a positive test indicates rotator cuff tear, specifically, supraspinatus muscle tearDrop arm test: a positive test indicates a supraspinatus tearExternal Rotation test: a positive test indicates an infraspinatus or teres minor tearLift-off test: a positive test indicates subscapularis pathologyTests for bicipital tenosynovitis and labral pathology
Yergason testSpeed's testBiceps load testO'Brien's test: positive test indicates a SLAP (or superior labral tear from anterior to posterior) tearApprehension test or Jobe's test: positive test indicates anterior glenohumeral instabilityRelocation testCross-arm test: positive test indicates acromioclavicular joint degeneration/arthritisAdson's sign tests for thoracic outlet syndromeLhermitte's sign may indicate cervical radiculopathy or spinal cord diseaseSpurling's test tests for cervical spine diseaseA meta-analysis in 2008 concluded that the diagnostic accuracy of individual tests in the shoulder examination was limited, specifically that the Hawkins-Kennedy test and the Speed test have no discriminatory ability to diagnose specific shoulder pathology, and that results of studies evaluating other tests were too statistically heterogeneous to make meaningful conclusions about their diagnostic accuracy.
Examination of the shoulder can be complex because the shoulder can present with more than one pathology at a time.
