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 due to the painful restriction of movement (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 prominent bone points, tendons, ligaments; musculature; joint (joint effusion); soft tissue swelling; tenderness (localization: above the joint space of the shoulder joint, ventral side (towards the front of the body)).
- Measurement of joint mobility and range of motion of the joint (according to the neutral zero method: range of motion is expressed 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). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
- Functional tests for differential diagnostic clarification:
- Check 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 (indicating excessive extensibility).
- 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)
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
