1. ANATOMY AND PHYSICAL EXAM OF THE SHOULDER
David Privitera, MD
Orthopaedic Surgeon
Western New York Sports and Ortho

2. Location 2619 Culver Rd Suite 2A
Across from Wambachs Garden center just off 104
Shared office with Whitbeck Spinal Associates
Onsite Xray, MRI, CT
RGH EMR

3. Shoulder Exam Outline The once over Diagnostic Clustering Cervical
Scapula
Loss of Passive Motion
Rotator Cuff
LHB/SLAP
AC joint
Instability

4. Start with the Neck!
ROM
Spurling
Recreation of Pain

5. Palpating Basic Glenohumeral Anatomy
Clavicle
Coracoid
AC joint
Subacromial Space
Long Head of Biceps/LT

6. Palpation of Anatomy Clavicle Coracoid AC joint Subacromial Space
Long Head of Biceps/LT

7. Look at their Scapula
Look for atrophy

8. Look at their Scapula Trapezial shrug Rhomboid squeeze
Scapular dyskinesis
Lateral winging

9. Look at their Scapula Trapezial shrug Rhomboid squeeze
Scapular dyskinesis
Lateral winging

10. Look at their Scapula Trapezial shrug Rhomboid squeeze
Scapular dyskinesis
Scapular Winging
Lateral (trapezial/CN XI palsy
Lateral winging

11. Look at their Scapula Trapezial shrug Rhomboid squeeze
Scapular dyskinesis
Scapular Winging
Lateral (trapezial/CN XI palsy
Medial (serratus anterior/ long thoracic n palsy)
Medial winging

12. Assess ROM Don’t be fooled by a quick exam!!!
loss of ER very notable at forward flexion and at pt’s side
Don’t be fooled by a quick exam!!!

13. Assess ROM
(Chronic bilateral glenohumeral dislocations)

14. Assess ROM Restricted Excessive Passive=Active Passive>Active
think DJD, capsulitis, malunion
Passive>Active
think cuff pathology
Excessive
Think tissue laxity/MDI, rare subscap
Active/Passive
Forward Flexion
Abduction
ER at neutral
Isolated Abduction
ER at 90
IR at 90

15. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

16. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

17. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

18. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

19. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

20. Assess ROM Active/Passive Forward Flexion Abduction ER at neutral
Isolated Abduction
ER at 90
IR at 90

21. Loss of Passive Motion Loss of ER/Abduction Adhesive Capsulitis DJD
Anterior/Posterior capsule contractures

22. Rotator Cuff Supraspinatus in plane
Supraspinatus extended plane (anterior cuff)

23. Rotator Cuff
Infraspinatus ER strength

24. Rotator Cuff
Subscapularis Belly Press strength Upper Border Subscapularis Bear Hug

25. Rotator Cuff
Teres Minor/Infraspinatus Hornblower sign

26. Long Head of Biceps/ Super Labral Complex
TTP LHB
Yergason
Speed
O’brien
Crank
Mayo Shear

27. Long Head of Biceps/ Super Labral Complex
TTP LHB
Yergason
Speed
O’brien
Crank
Mayo Shear

28. Long Head of Biceps/ Super Labral Complex
TTP LHB
Yergason
Speed
O’brien
Crank
Mayo Shear

29. AC symptoms
TTP AC joint
+AC shear
+Cross Body adduction

30. Anterior Instability Anterior Apprehension + Relocation
Anterior Load and shift

31. Posterior Instability
Forward flexion, IR, adduction
Jerk Sign
Posterior Load & Shift

32. Multidirectional Instability PE
Signs of hyperlaxity
(1) extension of the wrist & MCPJ  fingers are parallel to the dorsum of the forearm,
(2) passive apposition of thumbs to flexor forearm,
(3) hyperextension of the elbows (>10°)
(4) hyperextension of the knees (>10°)
(5) flexion of trunk with the knees ext palms on
the floor
(6) Hyperabduction of shoulder
Sulcus (Should reduce in ER)

33. Finish with Neurovascular
C5-T2
Median
Radial
Ulnar
Axillary
Radial pulse

34. Thank you