Shoulder Pain (Omalgia): 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; posture, shoulder and pelvic position).
    • Axis deviations of the spine
    • Malpositions (deformities, contractures, shortenings).
    • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Shoulder region: [signs of inflammation, hematoma (bruise), scars; swelling; atrophy; deformities (shoulder, thorax, spine); axis misalignment, asymmetries; scapula upright (shoulder blade upright)]
  • Palpation: examination of the shoulder girdle for localized tenderness, hyperthermia, myogelosis (nodular or bulbous, clearly circumscribed hardening in the muscles; colloquially known as hard tension), muscle atrophy; examination of the adjacent jointsExamination 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.

  • Functional tests for differential diagnostic clarification:
    • Testing of active and passive mobility (global function):
      • 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:
      • 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.
    • Isometric function tests
    • Stability testing (anterior instability, posterior instability, inferior instability); acromioclavicular joint testing (trauma, degenerative); general ligament laxity testing (indicating excessive extensibility).
  • Health check

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