Shoulder (standard tests)

Case 2

You are doing an internship at a general practitioner's office. Your supervisor has scheduled a previously healthy 40-year-old man to see you for a clinical examination due to right-sided shoulder pain. The man reports that he works as an electrician. Over the past month, he has been working long days with installation in a new building. He has noticed increasing pain in his right shoulder, especially with overhead work at his job.

Shoulder examination

• Perform a standard shoulder examination
  • Inspection
  • Active movement
  • Passive movement
  • Isometric movement
  • Palpation

1. You perform an inspection; what do you focus on?
2. You ask the patient to perform active movements, what do you expect to find?
3. You perform passive movements, what do you expect to find?
4. You perform isometric movements. The patient reports local shoulder pain during external rotation; which muscles in the rotator cuff are important for external rotation? Finally, you palpate the AC joint, locate and palpate the joint, and demonstrate a test for pain provocation.

Shoulder inspection

Active shoulder movement

Passive shoulder movement

Isometric shoulder movement

Shoulder palpation

Clinical findings

• Upon inspection, you see that there is moderate disuse atrophy in the deltoid muscle.
• You find a painful arc (60-120°) with active elevation of the arm.
• On examination of passive abduction no pain, slight pain at the back of the shoulder joint with passive internal rotation.
• On isometric testing pain with external rotation.
• No tenderness on palpation in the muscles or in the AC joint.

Cases