Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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FUNCTIONAL EXAMINATION OF THE SHOULDER

Introduction/general remarks

Shoulder lesions give rise to pain felt mostly in the proximal part of the upper limb. The shoulder examination is therefore commonly used in
the diagnosis of upper arm pain. However, the examiner should realize that symptoms in the region of the shoulder can also originate from
the cervical spine, the upper thoracic spine and the shoulder girdle. The examination of the shoulder is to be considered as an element in the diagnostic procedures for lesions of the upper quadrant.

middle portion of the deltoid and by the long head of biceps. Rotation of the scapula is done mainly by the serratus anterior muscle,
supported by the trapezius muscle, especially towards the end of range. The movement also stretches and/ or squeezes several structures, such as the capsule of the glenohumeral joint,
the subdeltoid bursa, and the sternoclavicular and acromioclavicular ligaments.Meaning.

This a very non-specific test which is almost always disturbed when a shoulder or shoulder girdle pathology is present. It also gives
an idea of the patient’s willingness to cooperate.Pain at mid-range may indicate a structure in between the humeral head and the coracoacrormal arch – either one of the tendons of supraspinatus,
infraspinatus, subscapularis, long head of biceps, or the subacromial bursa or inferior acromioclavicular ligament – being painfully pinched.
The patient often avoids painful impingement by adding an anterior component over part of the movement.

Limitation with or without pain occurs in shoulder arthritis or arthrosis, in certain extracapsular lesions and in some neurological conditions
causing weakness of the shoulder elevators.
• The movement is stopped before the end of
the possible range is reached.
• At the end of range the arm is taken
backwards in a sagittal plane.
• Lnsufficient counter-pressure results in the
subject Side-flexing the body.

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