Shoulder Lesions: Examination

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).
      • 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).
    • 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 for 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? Palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; tenderness (localization! )Examination procedure: starting medially with the sternoclavicular joint (sternoclavicular joint), followed by clavicle (clavicle), acromio-clavicular joint (ACG; AC joint; acromioclavicular joint)) with simultaneous stability testing, then processus coracoideus (coracoid process), sulcus intertubercularis (groove on the humerus) and tuberculum majus and minus.
    • Determination of the range of motion of the shoulder joint according to the neutral-zero method both actively and passively in a side-by-side comparison: (Neutral-zero method: the range of motion is given as the maximum deflection 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. ); Standard values:

      Comparison measurements with the contralateral joint (side comparison) can reveal even small lateral differences.

    • Special inspection of the shoulder, including side comparison – active/passive range of motion, functional tests:
      • 90-degree supraspinatus test (Jobe’s test) – The test is performed as part of the clinical examination of the shoulder joint an impingement syndrome; especially involvement of the supraspinatus muscle and the supraspinatus tendon can be confirmed or excluded. Performance of the test: The patient’s arm is abducted 90° (i.e., guided parallel to the ground), then moved forward 30° and the hand is internally rotated (rotational movement of an extremity about its longitudinal axis in which the direction of rotation points inward when viewed from the front). In this position, only the supraspinatus muscle is tensed in isolation from the entire rotators. Occurrence of pain during static holding speak for a lesion of the mentioned muscle.
      • Patte test (synonym: external rotation test according to Patte): the patient’s arm is abducted 90 ° (i.e. guided parallel to the floor) and then pressed backwards against the resistance of the examiner. Occurrence of pain speak for a lesion of the M. supraspinatus and the M. teres minor.
      • Impingement testing:
        • Hawkins test: here, at 90° of flexion (i.e., with the arm moved forward in the horizontal plane), internal rotation (rotational movement of an extremity about its longitudinal axis, with the direction of rotation pointing inward when viewed from the front) is forced.
        • Neer test: the patient’s shoulder blade is fixed with a strong grip by the examiner, then the corresponding arm is passively internally rotated and flexed (i.e., lifted forward) to provoke a bump of the humeral head on the acromion (shoulder bone).
        • Painful Arc: In this case, pain is triggered by active abduction (lateral displacement or spreading of a body part away from the center of the body or the longitudinal axis of an extremity), especially in the range between 60° to 120°. In contrast, passive movements can be painless.
      • If necessary, further testing procedures such as: Testing of the external rotators (M. infraspinatus, M. teres minor); Testing of the M. subscapularis; Instability tests (so-called “lag-signs”).
    • Assessment of blood flow, motor function and sensitivity:
      • Circulation (palpation of pulses).
      • Motor function: testing of gross strength in a lateral comparison.
      • Sensibility (neurological examination)
  • Further orthopedic examinations wg :
    • Differential diagnoses:
      • Biceps tendon rupture – Generic term for rupture of at least one tendon of the biceps brachii muscle (two-headed arm flexor muscle). A distinction is made between proximal biceps tendon rupture (in the shoulder area) and the distal rupture (in the elbow area).
      • Bursitis (bursitis) in rheumatoid arthritis (pcp).
      • Mishealed tuberculum majus (large humeral hump).
      • Frozen shoulder (syn: periarthritis humeroscapularis, painful frozen shoulder and Duplay syndrome) – extensive, painful suspension of shoulder mobility.
      • Impingement syndrome (English “collision”) – the symptomatology of this syndrome is based on the presence of a constriction of the tendon structure in the shoulder joint.and thus a functional impairment of joint mobility. It is mostly caused by degeneration or entrapment of capsular or tendon material. Degeneration or injury of the rotator cuff is the most common cause here. Symptom: Affected patients can hardly lift their arm above shoulder height due to the increasing impingement of the supraspinatus tendon. The actual impingement occurs subacromially, which is why this is called subacromial syndrome (short: SAS).
      • Contracture of the dorsal capsule
      • Osteophytes (bone attachments) in the acromioclavicular joint region.
      • Pseudarthrosis – disease caused by the failure of a fracture (bone fracture) to heal.
      • Shoulder pain caused by vertebragen (caused by the spine), vascular (caused by the blood vessels) or neurogenic (caused by the nervous system)
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.