The Exam for Shoulder Pain - Stanford Medicine 25

Summary

Dr. Brenda Christopher offers an insightful overview of the clinical examination process for shoulder pain, emphasizing the importance of assessing range of motion and identifying common pathologies such as rotator cuff injuries, impingement, and adhesive capsulitis. She demonstrates various diagnostic tests, including the Speed's, Neer's, and Hawkins-Kennedy tests, and discusses the signs of chronic shoulder instability and labral tears. This comprehensive guide is essential for medical professionals looking to enhance their examination skills.

Takeaways

• 👕 Start by having the patient undress to assess for range of movement limitations or functional abnormalities.
• 🔍 Initial inspection involves looking at the front, side, and back for muscle bulk and asymmetrical bony abnormalities.
• 🌟 Before examining the shoulder, check the cervical spine to ensure the pain is not originating from there.
• 📏 Assess range of movement through various positions like forward flexion, abduction, crossbody adduction, and internal/external rotation.
• 🆚 Compare the range of motion on both sides to identify any discrepancies.
• 👀 Observe the scapula for any asymmetries or abnormal motion during the range of motion tests.
• 💪 Targeted clinical examinations for common shoulder pathologies include tests for the rotator cuff tendons and other structures.
• 🤲 Test the rotator cuff by assessing the power and pain in supraspinatus, infraspinatus, teres minor, and subscapularis.
• 📉 Impingement tests include the Neer's, Empty Can, and Hawkins-Kennedy tests to replicate symptoms of supraspinatus pinching.
• 🤕 Palpation over the anterior joint line can reveal tenderness and subacromial-subdeltoid space issues.
• 🚑 Adhesive capsulitis is indicated by a reduction in both active and passive range of movement, often with scapula motion asymmetry.
• 🤹‍♂️ Specialized tests for biceps tendon pathology include Speed's and Yergason's tests, assessing for pain and abnormal movement.
• 🛑 Acromioclavicular pathology is diagnosed by localized pain over the AC joint and night pain when rolling over.
• 🔄 The Scarf test and painful arc in abduction are indicative of AC joint issues.
• 👐 Sulcus sign and apprehension relocation test are used to assess for shoulder instability and labral tears or SLAP lesions.
• 🏥 Acute lesions present with anterior joint line fullness and loss of power on resisted movements.

Q & A

What is the first step in the clinical examination of a patient with shoulder pain according to Dr. Brenda Christopher?

The first step is for the patient to take off their shirt to assess for any limitation of range of movement or functional abnormalities.

Why is it important to examine the cervical spine before conducting a shoulder examination?

It is important to ensure that no pathology is originating from the cervical spine, confirming that the issue is purely with the shoulder.

What are the different types of movements assessed during the range of movement examination of the shoulder?

The movements assessed include forward flexion, abduction, crossbody adduction, external rotation, extension, and internal rotation.

What is the purpose of comparing the range of motion of the right and left shoulders during the examination?

Comparing both sides helps identify any asymmetries that may indicate a problem or pathology in the shoulder.

What is the significance of observing the scapula during the range of motion examination?

Observing the scapula helps identify any asymmetries or abnormalities in scapular motion, which can indicate a pathology in the front of the shoulder.

Which structures are tested in the rotator cuff examination?

The rotator cuff examination tests the supraspinatus, infraspinatus, teres minor, and subscapularis tendons.

How is the power of the supraspinatus muscle tested during the clinical examination?

The power is tested with the patient's arm in 90 degrees of abduction and 30 degrees of forward flexion, pushing down against resistance.

What is the purpose of the 'empty can test' in the rotator cuff examination?

The 'empty can test' assesses the power of the supraspinatus and infraspinatus muscles by having the patient simulate the action of emptying a can by bringing their thumb to the floor.

What is the 'Gerber's lift-off' test used to assess?

Gerber's lift-off test is used to assess the integrity of the subscapularis muscle, checking for internal rotation lag sign.

How can the strength of the serratus anterior muscle be assessed?

The strength of the serratus anterior is assessed by having the patient perform a standing pushup and observing for any winging of the scapula.

What are the three specialist tests for shoulder impingement mentioned in the script?

The three specialist tests for impingement are the Neer's test, the Empty can test, and the Hawkins-Kennedy test.

What is the purpose of palpation over the anterior joint line in patients with impingement?

Palpation over the anterior joint line is useful to check for tenderness and to reveal the subacromial and subdeltoid space, which can be affected in patients with impingement.

What are the Jurgis and Speed's tests used to assess?

Jurgis test assesses the biceps tendon with resisted supination, while Speed's test evaluates it with resisted forward flexion, both checking for pain or abnormalities.

How is adhesive capsulitis typically presented in terms of range of movement?

Adhesive capsulitis usually presents with a reduction in both active and passive range of movement, with external rotation being the first to be affected.

What is the purpose of the sulcus sign test for assessing shoulder instability?

The sulcus sign test assesses for shoulder instability by applying a downward force on the humerus and looking for a sulcus or gap that appears over the lateral deltoid region.

What is the apprehension and relocation test used to assess?

The apprehension and relocation test is used to assess shoulder instability by applying downward pressure and observing if it causes pain or discomfort, which then decreases with relocation.

What are the common tests for labral tears or SLAP lesions?

The common tests for labral tears or SLAP lesions are the Speed's test, O'Brien's test, and the Crank test.

How can acute lesions in the shoulder be identified during clinical examination?

Acute lesions can be identified by the presence of anterior joint line fullness and a loss of power on resisted movements.