CAN YOU CREATE A STEP BY STEP GUIDE FOR THE SHOULDER EXAMINATION WITH PICTURES FOR EACH STEPS
Reading File
Reading File
Finding Sources
Finding Sources
Searching Images
stepwise clinical shoulder examination inspection palpation range of motion strength special tests diagram
Searching PubMed
"shoulder" AND "physical examination"
Searching the Web
shoulder examination clinical inspection palpation range of motion special tests guidance
Reading File
Reading File
Reading File
Reading Web Page
https://www.aafp.org/afp/2000/0515/p3079
query_images_db
Finding Sources
query_images_db
query_images_db
Generating Image
An educational eight-panel clinical shoulder examination picture guide. Show a fully clothed patient with shoulder and upper arm exposed and a clinician performing: 1 observation from front and back, 2 palpation of clavicle and acromioclavicular joint, 3 active shoulder flexion and abduction, 4 internal and external rotation with elbow at side, 5 resisted empty-can supraspinatus strength test, 6 Hawkins impingement test at 90 degrees forward flexion with internal rotation, 7 cross-body adduction test for acromioclavicular joint, 8 anterior apprehension test. Clear medically accurate anatomy and hand positioning, no text labels.
Step-by-step shoulder examination guide
Before starting: Explain the examination, obtain consent, expose both shoulders and upper arms, and compare the symptomatic side with the other side throughout. Stop if the person has severe pain, obvious deformity after trauma, numbness, a cold/pale arm, or suspected dislocation.
Picture key
| Panel | Examination step |
|---|---|
| 1 | Inspection |
| 2 | Palpation |
| 3 | Flexion and abduction |
| 4 | Internal and external rotation |
| 5 | Empty-can strength test |
| 6 | Hawkins impingement test |
| 7 | Cross-body adduction test |
| 8 | Apprehension test |
The usual sequence is inspection, palpation, range of motion, strength, then focused provocative tests, as outlined by AAFP shoulder assessment guidance.
1. Inspect - look from the front, side, and back
Position: Patient standing or sitting, arms relaxed at the sides.
Look for:
- Shoulder level and contour symmetry
- Swelling, bruising, redness, skin lesions, or surgical scars
- Prominence or step deformity at the clavicle or AC joint
- Muscle wasting: deltoid, supraspinatus, infraspinatus
- Scapular winging or abnormal scapular movement
Ask the patient to slowly raise both arms. Observe for pain, asymmetry, scapular dyskinesis, or compensatory shoulder shrugging.
A squared or flattened shoulder contour can suggest dislocation, whereas deltoid wasting may reflect axillary nerve dysfunction. S Das A Manual on Clinical Surgery, p. 181.
2. Palpate - compare both sides
Position: Patient relaxed with arms by their sides.
Palpate in order:
- Sternoclavicular joint
- Clavicle along its entire length
- Acromioclavicular (AC) joint
- Acromion and coracoid process
- Bicipital groove, just medial to the anterior deltoid
- Greater tuberosity and subacromial region
- Scapular spine, medial border, and posterior joint line
Check: temperature, tenderness, swelling, crepitus, masses, and bony irregularity.
Also test sensation over the lateral upper arm, the “regimental badge” area supplied by the axillary nerve.
Tenderness directly over the AC joint supports AC-joint pathology; bicipital-groove tenderness can occur with long-head biceps disease. Bailey and Love's Short Practice of Surgery, p. 507.
3. Assess active range of motion
Ask the patient to perform each movement actively. Compare sides and record pain, limitation, and any painful arc.
| Movement | Instruction | Typical reference range |
|---|---|---|
| Flexion | Raise straight arms forward and overhead | 0-180° |
| Extension | Move arms backwards | 0-60° |
| Abduction | Raise arms sideways overhead | 0-180° |
| Adduction | Bring arm across body | Variable |
| External rotation | Elbows by sides, rotate forearms outward | About 0-60° |
| Internal rotation | Reach thumb up the spine behind the back | Record vertebral level reached |
Look for a painful arc: pain during abduction around 60-120° may occur with rotator-cuff-related or subacromial pain.
4. Assess passive range of motion
Support the patient’s arm and repeat flexion, abduction, internal rotation, and external rotation while the patient relaxes.
Interpretation:
- Active restriction with relatively preserved passive motion: consider pain inhibition, weakness, or rotator cuff pathology.
- Both active and passive motion restricted: consider capsular stiffness, adhesive capsulitis, or glenohumeral osteoarthritis.
- Marked loss of external rotation is particularly helpful for identifying glenohumeral stiffness.
5. Test rotator cuff and shoulder strength
Compare strength on both sides. Test only within the patient’s tolerable range.
A. Supraspinatus - Empty-can / Jobe test
- Abduct arm to about 90° in the scapular plane, slightly forward of the body.
- Turn thumb downward, as if emptying a can.
- Apply gentle downward pressure while the patient resists.
- Positive: pain or weakness, which may indicate supraspinatus or rotator cuff pathology.
B. Infraspinatus and teres minor - External rotation resistance
- Elbows at 90° and tucked against the body.
- Ask the patient to rotate forearms outward against your resistance.
- Weakness or pain may suggest posterior rotator cuff involvement.
C. Subscapularis - Lift-off test
- Place the back of the hand on the lower back.
- Ask the patient to lift the hand away from the back against resistance.
- Inability or marked weakness suggests subscapularis dysfunction.
D. Deltoid and axillary nerve
- Resist abduction, particularly from roughly 15° to 90°.
- Combine with sensation over the lateral upper arm.
6. Test for subacromial pain or impingement
Hawkins test
- Flex shoulder and elbow to 90°.
- Stabilize the arm, then gently internally rotate the shoulder.
- Positive: familiar anterolateral shoulder pain can suggest subacromial pain or rotator cuff irritation.
Neer test
- Stabilize the scapula.
- Passively elevate the internally rotated arm in forward flexion.
- Positive: pain near end-range may indicate subacromial pain.
Do not use either test alone to make a diagnosis. The AAFP clinical evaluation review describes Hawkins testing as forward elevation to 90° followed by internal rotation.
7. Test the acromioclavicular joint
Cross-body adduction test
- Flex shoulder to 90°.
- Move the arm across the chest toward the opposite shoulder.
- Positive: localized pain over the AC joint suggests AC-joint pathology.
8. Test for anterior instability
Apprehension test
- With the patient sitting or supine, abduct shoulder to about 90°.
- Slowly externally rotate the arm.
- Positive: a feeling that the shoulder will “come out,” not merely pain.
Relocation test
- In the same position, apply gentle posterior pressure to the humeral head.
- Relief of apprehension supports anterior instability.
Do not perform this test in acute trauma, obvious dislocation, or when fracture is possible.
9. Complete the examination
- Examine the neck: cervical motion and radicular symptoms can refer pain to the shoulder.
- Examine the elbow when relevant.
- Perform a brief distal neurovascular check: radial pulse, hand movement, and sensation.
- Summarize: side, tenderness, active/passive range, strength, provocative tests, and neurovascular status.
Quick documentation template
Right/left shoulder: no/positive deformity, swelling, scar, or muscle wasting. Tenderness at ____. Active ROM: ____. Passive ROM: ____. Strength: supraspinatus __/5, external rotation __/5, internal rotation __/5. Hawkins __, cross-body adduction __, apprehension __. Distal sensation and pulse intact/impaired.
Clinical caution: special tests increase or decrease suspicion for a condition but should be interpreted alongside history, inspection, movement pattern, strength, and, when indicated, imaging. A 2024 systematic review found that examination maneuvers have variable diagnostic accuracy for rotator cuff tears and subacromial bursitis (PMID 39702033).
This is a shared conversation. Sign in to Orris to start your own chat.