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 the vertebral bodies, tendons! Ligaments; musculature (tone, tenderness, contractures of the paraverebral musculature); soft tissue swelling; tenderness (localization! ; restricted mobility (movement restrictions of the spine); “tapping signs” (testing the painfulness of the spinous processes, transverse processes, as well as the costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, from the front, side or saggital; hyper- or hypomobility?
- Palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; tenderness (localization!).
- If the shoulder is involved: special inspection of the shoulder, also in lateral comparison – active/passive range of motion, functional tests:
- Patte test (synonym: external rotation test according to Patte): the patient’s arm is abducted 90° (i.e., guided parallel to the ground) 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.
- Elevation of the arm (lifting the arm above an angle of 90 °) leads to pain; usually only abduction (leading away) of the arm in external rotation or internal rotation is possible
- 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 lateral comparison.
- Sensibility (neurological examination)
- Inspection (viewing).
- Further (orthopedic) examinations wg :
- Differential diagnoses:
- Arthritis urica – joint inflammation based on a disorder of uric acid metabolism.
- Bacterial infection, unspecified
- “Frozen shoulder” (synonym: periarthritis humeroscapularis, painful frozen shoulder, and Duplay syndrome) – Adhesive capsulitis; extensive, painful abolition of shoulder mobility (painful frozen shoulder).
- 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 barely 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).
- Neuralgic shoulder amyotrophy / muscle atrophy.
- Omarthrosis (degenerative changes of the articular cartilage of the shoulder joint).
- Rupture (tear) in the affected region.
- Shoulder pain caused by changes in the spine (vertebragen), vessels (vascular), or nerves (neurogenic)
- Cervical disc herniation (herniated disc in the cervical spine).
- Differential diagnoses:
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.