A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing).
- Shoulder region [signs of inflammation, hematoma (bruise), scars; swellings; atrophies; deformities (shoulder, thorax, spine); axial misalignment, asymmetries; scapula (shoulder blade) elevation]
- Palpation (palpation) of the shoulder girdle [local pressure pain, hyperthermia, myogelosis (nodular or bulbous, clearly circumscribed hardening in the muscles; colloquially also referred to as hard tension), muscle atrophy [muscle breakdown]; examination of the neighboring joints]
- Observation: undressing, posture, shoulder and pelvic position.
- Skin (Normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
- Gait (fluid, limping).
- Body or joint posture (upright, bent, gentle posture).
- Malpositions (deformities, contractures, shortenings).
- Muscle atrophies (side comparison!, if necessary circumference measurements).
- Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
- Inspection and palpation of the thyroid gland [due topossible cause: hyperthyroidism (hyperthyroidism)].
- Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ; restricted mobility (spinal movement restrictions); “tapping signs” (testing painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, anterior, lateral or saggital; hyper- or hypomobility?
- Measurement of joint mobility and range of motion of the glenohumeral joint (according to the neutral zero method: range of motion is expressed as the maximum displacement of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
- Assessment of blood flow, motor function and sensitivity:
- Circulation (palpation of pulses).
- Motor function: testing of gross strength in lateral comparison.
- Sensibility (neurological examination)
- Inspection (viewing).
- Clinical tests for differential diagnosis:
- Testing of active and passive mobility: apron grip (synonym: internal rotation test of the shoulder), neck grip (synonym: external rotation test of the shoulder); documentation from which angle degree of the scapula is moved along, presence of snapping, shoulder cracking, crepitations.
- Impingement tests (impingement signs according to Neer): an elevation (lifting) of the arm leads to a painful compression of the rotator cuff (group of four muscles and their tendons that form the roof of the shoulder joint) and the bursa at the anterior inferior edge of the acromion
- Isometric functional tests
- Stability testing (anterior instability, posterior instability, inferior instability); acromioclavicular joint testing (trauma, degenerative); general ligament laxity testing.
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
