1. Shoulder Evaluation

2. Overview Soft tissue palpation Muscular anatomy Evaluation
Special tests

3. Soft Tissue Palpation Sterno-Clavicular (SC) ligament
Acromio-Clavicular (AC) ligament
Coraco-Clavicular (CC) ligament
Coraco-Acromioclavicular (CA) ligament
Glenohumeral joint
Subacromial bursa
Subdeltoid bursa

4. Muscular Anatomy Supraspinatus Infraspinatus Teres minor Subscapularis
Pectoralis major
Pectoralis minor
Scalenes
Teres major
Latissimus dorsi
Serratus anterior
Biceps brachii
Triceps brachii
Rhomboid major & minor
Deltoid

5. Intrinsic Musculature: Supraspinatus
O: Supraspinous fossa
I: Superior greater trochanter
A:?
N: Suprascapular nerve

6. Intrinsic Musculature: Infraspinatus
O: Infraspinous fossa
I: Posterior greater tubercle
A: ?
N: Suprascapular nerve

7. Intrinsic Musculature: Teres Minor
O: Lateral scapula
I: Posterior greater tubercle
A: ?
N: Axillary nerve

8. Intrinsic Musculature: Subscapularis
O: Anterior surface of scapula (subscapular fossa)
I: Lesser tubercle of humerus
A: ?
N: Subscapular

10. Pectoralis Major O: Clavicle, sternum, and ribs
I: Intertubercular groove of humerus
A: Int. rot, horiz. add, flex, add below 90, abd above 90
N: pectoral

11. Pectoralis Minor O: Anterior surfaces of ribs 3-5 I: Coracoid process
A: Abd, Down rot, dep
N: Medial pectoral

12. Scalenes O: Transverse processes of C2-C7 I: First & second ribs
A: Rib elevation & head rotation (same side)
I: Spinal nerves C3-C8

13. Teres Major O: Inferior 1/3 of lateral border of scapula
I: Medial intertubercular groove of humerus
A: Ext, add, IR
N: Lower subscapular

14. Latissimus Dorsi
O: Ilium, sacrum, lumbar vertebrae, and lower 6 thoracic vertebrae
I: Anterior humerus
A: Add, in rot, ext
N: Thoracodorsal

15. Serratus Anterior O: Ribs 1-9 on lateral thorax
I: Medial border of scapula
A: Abduction, up rot
I: Long thoracic nerve

16. Biceps Brachii O: LH-Superior glenoid ; SH-Coracoid
I: Radial tuberosity
A: Elbow flexion & supination, shoulder flexion
N: Musculocutaneous

17. Triceps Brachii
O: LoH- infraglenoid lip of scapula; LaH- posterior humerus; MH- medial posterior humerus
I: Olecranon process
A: Elbow extension, shoulder extension
N: Radial

18. Rhomboids O: Spinous processes of C5-T5 I: Medial border of scapula
A: Adduction, down rot, elev
N: Dorsal scapular nerve

19. Deltoid O: Clavicle, acromion, & scapular spine I: Lateral humerus
A: flex, ext, in rot, ex rot, add, abd, horiz add, horiz abd (everything!)
N: Axillary

20. Evaluation Passive/Active ROM (Shoulder): Flexion Extension Abduction
Adduction
External rotation
Internal rotation

21. Evaluation Passive/Active ROM (Scapula): Elevation Depression
Abduction (protraction)
Adduction (retraction)
Internal rotation
External rotation
Circumduction
Apley scratch test

22. Special Tests (31) Fracture/sprain test (1) Rotator cuff tests (6)
Glenohumeral instability tests (11)
Biceps tendon tests (6)
Impingement tests (3)
Thoracic outlet tests (4)

23. AC-SC Stress Test (fracture/sprain)
The examiner palpates the patient’s clavicle and manipulates it inferiorly, superiorly, medially, and laterally
Pain or crepitus indicates a positive test for possible clavicular fracture

24. Drop Arm Test (rotator cuff):
Patient begins by abducting both arms to 90 degrees
Examiner then pushes downward on both arms with equal force
Test is positive for rotator cuff injury if patient experiences pain or pt’s arm(s) can be pushed down without springing back into position once the examiner suddenly stops applying the downward force

25. Empty Can Test (rotator cuff):
Pt in standing, the examiner instructs pt to internally rotate the shoulder and point the thumb toward the floor
Examiner then resists the pt’s movement into full abduction
Examiner should perform the test in four different planes
Abduction between 0 and 45 degrees in front of the body = supraspinatus
Abduction/flexion greater than 45 degrees in front of the body but less than 90 degrees = infraspinatus
Shoulder flexion in the empty can position straight out in front of the body = teres minor
Test performed across the body = subscapularis
Any pain or weakness in any of the movements is a positive test for strain of the affected rotator cuff muscle(s).

26. Arms Over Head (rotator cuff):
Pt in standing, the examiner instructs the pt to externally rotate the shoulders and actively lift both arms overhead
Test positive for rotator cuff strain if the pt notes pain and/or is unable to perform the movement 

27. High Five Test (rotator cuff):
Pt begins standing with the arms abducted to 90 degrees and externally rotated, and the elbows flexed to 90 degrees
From this position, pt’s hands will remain in the frontal plane, however, the palmar surface will be positioned anteriorly and the hands will be held overhead
Examiner then uses both of his/her hands to forcefully push the pt’s hands posteriorly while pt resists
Pain indicates a positive test for muscle strain to one or more of the rotator cuff muscles

28. Lift Off Sign (rotator cuff):
The examiner prepositions the pt with dorsal surface of pt’s hand over the lumbar spine (end range shoulder internal rotation)
Examiner applies resistance as pt attempts to lift the hand off the spine and push posteriorly
Weakness indicates a positive test for subscapularis muscular injury

29. Resisted Pull Test (tendinitis vs. bursitis):
Examiner stabilizes the pt’s involved upper arm and resists active shoulder external rotation and/or abduction
Pt is asked to rate his/her pain
Obvious pain is a positive sign for rotator cuff tendon pathology and/or subacromial bursitis
Examiner then applies a caudal pull to the upper arm, resulting in a traction force at the glenohumeral joint
During the pull, pt is instructed to repeat the resisted active shoulder external rotation and/or abduction
If pain was present when the test was performed with no pull, reduced pain with a pull is indicative of subacromial bursitis, while no change or increased pain is indicative of rotator cuff pathology.