Ortho Exam (Shoulder)

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Asks patient if they are in any pain prior to beginning examination

Gains consent and exposes the patient appropriately

Look

Inspects anteriorly

Inspects laterally

Inspects posteriorly

Inspects spine - checks for lordosis or scoliosis

Comments on 3 of; scars, bruising, muscle wasting, skin changes, casts or slings

Inspects for muscle wasting in the hand / thenar eminence

Feel

Screens for temperature change

Palpates the Sternoclavicular Joint (SCJ)

Palpates along the Clavicle

Palpates Acromioclavicular Joint (ACJ)

Palpates Acromion

Palpates Coracoid process

Palpates Head of the Humerus

Palpates along the spine of the scapula

Move

Active Movovement

Tests Flexion/Extension

Tests Abduction and Adduction

Tests Internal Rotation

Tests External Rotation

Candidate compares movements between the affected and unaffected sides

Passive Movements

Passive movement - repeats the above movements passively, whilst isolating the moving joint and checking for RoM and crepitus

Special Tests

Resisted External Rotation - test as such  

? Actioned by Infraspinatus + Teres Minor

Resisted Internal Rotation - test as such or as such 

? Actioned by Subscapularis

Resisted Supraspinatus empty can test / Jobe's test - test as such  

? Resisted abduction is actioned by the Supraspinatus muscle

Drop arm test - test as such  

? This demonstrates a total Supraspinatus tear with 77% specificity.

Please note there are many specific tests for rotator cuff tears, these vary based on location and teacher. The tests presented here are some of the most commonly used. If the candidate uses a different named test that isolates the appropriate rotator cuff muscles then give the marks.

Complete Examination

Prompts patient to redress

Completes the exam by offering to test distal neurovascular status, examine the joint above and below, and to discuss with a senior

Diagnosis and Interpretation

Requests appropriate investigation (Bedside, Bloods, Imaging (including XR with 2 views), Special tests)

Gives appropriate differential

Management

Offers an appropriate management plan (in ortho never forget pain relief, and to fast the patient with IV fluids if they need an operation)

Submit