Home > Rheumatology > Examination

Search

The shoulder joint - findings on examination

P = pain
L = limitation
W = weakness		 Arthritis
Trauma
?steroid sensitive
40Y+		 Acute sub-deltoid bursitis
20-60Y		 Acromio-clavicular joint Chronic sub-deltoid bursitis Supra-spinatus tendinitis
Inferior TPJ		 Supra-spinatus tendinitis
Inferior TPJ		 Supra-spinatus tendinitis
Tendon body		 Supra-spinatus tendinitis
MTJ		 Supra-spinatus rupture Infra-spinatus
Tendon TPJ
Superior aspect		 Infra-spinatus
Tendon TPJ
Inferior aspect		 Infra-spinatus
Tendon body		 Biceps tendon in groove Subacromial tenderness P = pain
L = limitation
W = weakness
Active elevation P & L -100°
 P & L		 P +/-           L           Active elevation
Passive elevation P & L -90°
 P & L		 P +/- (P)?   P P       P       Passive elevation
Painful arc     (P) P P   P   P P         Painful arc
Passive abduction -30°
P & L		 -30°
P & L		   (P)?   P         P       Passive abduction
Passive int rotation -60°
P & L		 -5°
P & L		 P +/- (P)?                     Passive int rotation
Passive ext rotation -5°
P & L		 -5°
P & L		 P +/- (P)?                     Passive ext rotation
Resisted adduction                             Resisted adduction
Resisted abduction         P+ P+ P+ P+ W           Resisted abduction
Resisted int rotation                             Resisted int rotation
Resisted ext rotation                   P++ P++ P++     Resisted ext rotation
Resisted elbow flexion                         P+   Resisted elbow flexion
Resisted elbow extension       (P)?                     Resisted elbow extension
Passive horizontal adduction P & L P & L P++                       Passive horizontal adduction
  -40Y steroid sensitive
IAS
Stretch		 First week IAS
After this self limiting (5w)		 No painful arc > DTM
Painful arc  > Sinfil (deep fibres)		 No limitation
?pain at end of range		 Sinfil or DTM Sinfil (deep) or DTM (strong) Sinfil (throughout) or DTM (strong) DTM only Sinfil torn ends Disinflammation)
?Surgery		 Sinfil or DTM Sinfil or DTM Sinfil or DTM DTM
Sinfil 		Bizarre symptoms/signs - if isolated ?Sinfil  

IAS = intra-articular steroid
Sinfil = steroid infiltration
DTM = deep transverse massage
TPJ = teno-periosteal junction
MTJ = musculo-tendinous junction
SA = subacromial

Examination of the shoulder