Medically Fit For Exams
Medically Fit For Exams

Shoulder examination

  • Wash your hands and introduce yourself to the patient
  • Check the patient's name and DOB
  • Explain what you are going to do, mention that it might be uncomfortable, and you will stop if they ask you to
  • Ask the patient to undress to expose both shoulders



  • Look from in front, from the side and behind – start with normal shoulder
  • Look for deformity/asymmetry, swelling, scars
  • Look for muscle wastage of deltoid, supraspinatus and infraspinatus
  • Look for winging of the scapular


  • Start with normal side
  • Palpate clavicle, starting from sternoclavicular joint, pressing firmly
  • Palpate acromioclavicular joint
  • Assess for tenderness, temperature, swelling and deformity
  • Palpate acromion, coracoid and scapular spine for tenderness



  • For each movement, start with the normal side to allow direct comparison
  • Assess function by asking the patient to:
    1. Put their hands behind their head
    2. Reach behind them up between the shoulder blades
    3. Making stirring movements using both hands/shoulders
  • Assess active movement:
    1. Flexion (forward) up to 180 degrees
    2. Extension (backwards) up to 60 degrees
    3. Abduction up to 150 degrees (can palpate inferior pole of scapular to assess how much movement comes from the scapular rotating vs glenohumeral joint
    4. External rotation, with elbow flexed to 90 degrees, normal is up to 90 degrees
    5. Internal rotation from above position, move hand to reach as far up the back as possible, normal is mid-thoracic
  • Assess passive movement in the same way


SPECIAL TESTS – carry out only tests that are indicated from history/examination

  • Impingement
    • Abduct the patient’s shoulder, passively
    • Let go once fully abducted, and ask the patient to adduct slowly
    • Pain between 60 degrees and 120 degrees = a painful arc
    • Indicated supraspinatus tendinitis
  • Scarf test/acromioclavicular joint pathology
    • Ask patient to actively flex both shoulder and elbow to 90 degrees and place their hand on the opposite shoulder
    • Pain indicates acromioclavicular pathology
  • Supraspinatus/Jobe’s test
    • Ask patient to abduct against resistance (stand behind, place hands one above elbow, one below and push), assess first 15 degrees
    • Jobe’s test = should abduction against resistance with thumb pointing down to the floor
    • Pain = tendonitis
    • Loss of power = tear of supraspinatus
  • Infraspinatus/Teres Minor
    • Ask patient flex shoulder to 30 degrees
    • Ask to externally rotate against resistance (stand behind, place one hand just above elbow, other around the wrist)
    • Pain = tendonitis
    • Loss of power = tear of infraspinatus/teres minor
  • Subscapularis/Gerber’s test
    • Ask the patient to place their hand on their back behind them (in the small of the back)
    • Apply resistance to their hand, and ask them to try to lift off against you
    • Pain = tendonitis
    • Loss of power = tear of subscapularis
  • Bicipital tendonitis
    • Supinate the forearm
    • Ask the patient to flex the elbow against resistance (place hand on biceps)
    • Pain = tendonitis
    • Loss of power = tear of biceps
  • Winged scapular
    • Ask the patient to push against a wall with both palms flat on the wall
    • Look for abnormal protrusion of scapular
    • Suggests damage to long thoracic nerve supplying the serratus anterior
  • Shoulder apprehension for previous dislocations
    • Ask patient to position their arm with shoulder abducted 90 degrees, and elbow flexed to 90 degrees, with fist in the air (think: gun show)
    • Stand behind them, put one hand on shoulder, one hand on elbow
    • Push forwards on shoulder, pull back on elbow
    • Apprehension/movement during this suggests previous dislocation



  • Palpate radial pulse. If not present, palpate brachial pulse
  • Check temperature and perfusion of the hand
  • Assess sensation in ‘regimental badge area’ – skin of inferior deltoid region – supplied by axillary nerve
  • Assess dermatomal sensation
  • State you would like to carry out a full neurovascular assessment of the limb



  • Ask about pain in the neck and elbow, as pain may be referred, or a result of compensation for injury in one of these joints
  • State you would like to fully examine these joints

Get social with us.

Print Print | Sitemap