Shoulder Examination Components

Patient Positioning and Examination Sequence

Position patient sitting with 90° elbow flexion and hand in supination on top of the thigh, as recommended by the American College of Rheumatology 1
For dynamic examination, have patient perform active and/or passive external and internal rotation of the humerus through full range of motion with 90° flexed elbow, according to the American College of Rheumatology 1
Assess scapular position and movement for winging or dyskinesia, as suggested by the American Academy of Physical Medicine and Rehabilitation 2

For athletes/throwers, assess shoulder motion, flexibility, strength, and other components of the kinetic chain, as recommended by the American Academy of Physical Medicine and Rehabilitation 3
Evaluate for scapular dyskinesis which may contribute to rotator cuff injury, according to the American Academy of Physical Medicine and Rehabilitation 4
For post-stroke patients, evaluate for hemiplegic shoulder pain with special attention to tone, strength, and joint alignment, as suggested by the International Journal of Stroke 5
Assess for Complex Regional Pain Syndrome (CRPS) with signs including pain/tenderness, edema, trophic skin changes, hyperesthesia, and limited range of motion, according to the International Journal of Stroke 5
For cancer patients, assess shoulder range of motion restriction, strength, impingement signs, and scapular mobility, as recommended by the American Academy of Physical Medicine and Rehabilitation 2

Evaluate both active and passive range of motion in all planes, including forward flexion (0-180°) 5, external rotation (0-90°) 1, and internal rotation (ability to reach up the back) 4
Test rotator cuff muscles individually, including supraspinatus (empty can test/Jobe's test) 1, infraspinatus and teres minor (external rotation) 1, subscapularis (lift-off test, belly press test) 5, and deltoid (resisted abduction) 1

Palpate the proximal humerus, lateral aspect of proximal humerus, and surrounding soft tissues for tenderness, as recommended by the American Academy of Physical Medicine and Rehabilitation 3
Assess the acromioclavicular joint, sternoclavicular joint, and bicipital groove, according to the American College of Rheumatology 1
Identify areas of swelling, warmth, or crepitus that may indicate inflammation, as suggested by the International Journal of Stroke 5

A thorough shoulder examination should include assessment of tone, strength, soft tissue changes, joint alignment, pain levels, and orthopedic changes, followed by appropriate imaging and targeted treatment based on the specific diagnosis, as recommended by the International Journal of Stroke 6
For limitations in range of motion, implement gentle stretching and mobilization techniques, focusing on external rotation and abduction, as suggested by the International Journal of Stroke 6, 7

Standard radiographs should be the initial imaging study for traumatic shoulder pain, including anteroposterior views in internal and external rotation, plus axillary or scapula-Y view, according to the Journal of the American College of Radiology 8
For suspected rotator cuff pathology, MRI without contrast, MR arthrography, or ultrasound are all appropriate depending on local expertise, as stated by the Journal of the American College of Radiology 9, 10
CT is superior for characterizing fracture patterns but inferior to MRI for soft tissue injuries, as noted by the Journal of the American College of Radiology 8

Gradually increase active range of motion while restoring alignment and strengthening weak shoulder girdle muscles, as recommended by the International Journal of Stroke 6, 7
For pain management, use analgesics such as acetaminophen or ibuprofen if no contraindications exist, as suggested by the International Journal of Stroke 6, 7
Consider corticosteroid injections for subacromial pain related to rotator cuff or bursa inflammation, as recommended by the International Journal of Stroke 6, 7

For hemiplegic shoulder pain following stroke, assess tone, strength, soft tissue changes, joint alignment, and pain levels, as recommended by the International Journal of Stroke 6, 7
To prevent Complex Regional Pain Syndrome (CRPS), utilize active, active-assisted, or passive range of motion exercises, as suggested by the International Journal of Stroke 6, 7
Consider early oral corticosteroids for CRPS management (30-50 mg daily for 3-5 days with tapering over 1-2 weeks), as recommended by the International Journal of Stroke 6, 7

For patients under 35 years with instability or questionable labral pathology, the American College of Radiology recommends using MRI or MR arthrography as the modalities of choice 11

The American College of Radiology suggests that MRI without contrast or ultrasound are equivalent first-line studies for suspected rotator cuff pathology after noncontributory radiographs, with a high appropriateness rating for questionable bursitis or biceps tenosynovitis 12
Muscle atrophy, particularly in the supraspinatus and infraspinatus fossae, suggests chronic rotator cuff pathology, as noted by the Journal of the American College of Radiology 12