Call 281-633-8600 for an appointment. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Specialist with offices in Houston, near the Houston Galleria, and in Sugar Land near First Colony Mall.
In this video, Dr. Bennett describes and demonstrates typical orthopedic shoulder exam tests that he uses with patients to help diagnose their injuries.
This is a transcript of Dr. Bennett’s Shoulder Exam Tests video.
Hello, my name is Dr. J. Michael Bennett. I’m an Orthopedic Sports Medicine Physician with the Fondren Orthopedic Group, and today I wanted to put together some basic videos just explaining exactly what happens in the doctor’s office regarding the physical exam. A lot of times patients will come into our office and we’ll run through a series of different tests. You’ll hear us using specific names for those tests, or you’ll see us typing in on a computer, or writing them down. A lot of times patients don’t really know exactly what’s going on or what we’re looking for.
I wanted to go ahead and clear away a little bit of the mystery behind that and go through exactly each test, and what we are looking for with each test, and why we do those tests.
So today we’re going to specifically focus on the shoulder exam. The initial shoulder exam begins just by inspection. You want to look at the shoulder and see exactly how the patient’s standing while relaxed. Sometimes the patients can be hunched upward, sometimes they can posture a little bit, raising they’re shoulder. Sometimes you can even see a little muscle atrophy where the muscles seem to be a little bit smaller on one side compared to the other side. You can even see sometimes deformity if you have a fracture or broken clavicle, bruising or swelling. You may even see a little bit of a discrepancy in regards to the scapula in the back where the scapulas tends to stick out a little bit more. All these are very important in regards to the physical exam.
So first off when we evaluate a patient, we just look at their shoulder generally speaking. The next thing we want to do is look at their range of motion and see what they actively can do on their own. So we have them start by going for forward flexion, all the way up as high as they can, and usually we’ll use a little tool called the goniometer to evaluate exactly what that measurement is, and it will tell us exactly how many degrees of motion that they have. If they have full range of motion they come on back down, they come on out to the side all the way up, all the way up, come on back down, we usually have them put their arms at their side, rotate outward, and then they rotate behind.
Okay, that gives us all plains of motion, forward flexion, abduction, external and internal rotation. If we see any discrepancies, that again is another sign that something is pathologically wrong with the shoulder. It could be a stiff shoulder, it could be a rotator cuff tear.
The next thing that we like to do is evaluate their muscle strength, okay. Have them put their arms at their side, have them gently push out, have them gently push in, have them hold their arms up with their thumbs down, and hold up and resist, okay. That actually looks at the strength regarding the external rotators of the shoulder, the internal rotators of the shoulder, as well as the deltoid, and the supraspinatus tendon. When they’re actually turning their thumbs downward that actually isolates the supraspinatus tendon so it actually will show us the strength. So if you have a patient that has a acute rotator cuff tear, they’ll try to resist you and that arms going to fall at their side, or they may just have a rotator cuff bruise or an inflammation.
The next thing you in the physical exam is palpate. And it usually starts with looking at the shoulder and you palpate the bony prominences across the shoulder. You start with the clavicle, you push across the clavicle over to the acromioclavicular joint here. If you have a patient that say was a football injury or skiing injury where they’re land directly on the shoulder, sometimes you can get a discrepancy right at the AC joint here, where you’ll see the clavicle higher than the acromion, and you’ll see a lump there. Sometimes you can get just a sprain there. This is also where you’re going to see a clavicle fracture. If you see a little bit of a bump right where the clavicle is or some swelling or bruising, that is indicative of an injury at the clavicle.
Next thing we do is we palpate the biceps tendon which is right around here. This is the long head of the biceps tendon and it actually extends from the top of the shoulder all the way down to the biceps muscle, and then you have another tendon down here to the elbow. Sometimes you can have a biceps rupture where as a patient will be lifting something heavy, they’ll feel a pop and then they’ll have some swelling here, and then they’ll have some fullness of this biceps, we call that a Popeye deformity. So that’s actually something we look for in the physical exam as well. Then, we just kind of push out here to the tuberosity region to see if there’s any injury to the tuberosity of the shoulder. That may indicate a fracture or a rotator cuff injury as well.
The next thing that we do is a series of specific tests that we use to isolate certain areas of the shoulder. The first test we’ll do is we abduct the shoulder and have the patient relax, and we just torque the shoulder just a little bit in different angles or across the body. This is called a Hawkins test and what that does is it kind of rotates the humeral head underneath the acromion, and if you have any inflammation or rotator cuff injury that’ll be painful to the patient.
The next thing we do, is we have the patient bring their arm up to their side with their thumb down again, reach all the way across their body like this, and then have them resist us, okay. And if you push directly down, and they drop their arm, that’s a positive Obrien’s Test and that can isolate the rotator cuff again and tell us if they have a rotator cuff problem. The next thing we want them to do is rotate their hand upward, hold their arm forward flexed like this and resist, okay. This is a Speeds Test, this isolates the long head of the biceps, so if you have an injury to the long head of the biceps they’ll have pain and they’ll drop their hand, okay. The next thing we have them do, is reach across their shoulder and scratch their other arm. If they can do that without pain then that means that their AC joint is okay. If it hurts them when they do that usually that means that they either have a clavicle injury or an AC joint injury, sometimes a biceps injury as well.
The next thing we do, we have them push in on their belly, stick their elbow out, and hold their arm out as strong as they can. If they can resist you without pain then you know the subscap tendon is okay, which is the tendon in the front of the shoulder. Sometimes if you have a patient that has a subscap tendon tear, they will not be able to bring their elbow out to their side, and will not be able to push down onto the belly, okay.
The next test we do is, if you have a patient with a history of dislocations or instability of the shoulder, if they bring their arm out to the side abducted, and you put a little bit of stress or pressure out here in different angles here, it creates a what we call an apprehension sign. That means that it feels like the shoulders going to pop out of joint and they become very uncomfortable when you do that position. If you do have a patient that’s had a history of dislocations I do not recommend that you do that with a lot of stress, because you could very well create a dislocation in the clinic. So if they’re at all apprehensive in that position, that’s a positive apprehension sign.
The next thing you can do is have the patient lay down on the table and you can evaluate their shoulder stability. You have the patient gently abduct their arm to their side, and you gently put some stress on the posterior aspect of the elbow, and see if the elbow slides in and out of the glenohumeral joint. You can do that with abduction external rotation, you can do it also with inferior translation, okay. There’s another way of doing this as well, is having them sit at their side and seeing if you can stress it downward.
Sometimes if you have patients that have multidirectional instability or a very loose shoulder, you’ll see what’s called a sulcus sign, where you pull down on the arm and you’ll see an indention in here at the acromion here as the humeral head subluxates inferiorly. Like I said before, if you have a patient that has multidirectional instability or a lot of laxity in the shoulder, be careful with this exam because you could very well create a dislocation if they’re very loose, or if they have any incompetency regarding the glenohumeral joint. So these are just a few of the basic exams regarding the shoulder and what we’re looking for when we’re doing the shoulder exam.
So hopefully that’ll help and if you have any questions or comments please feel free to go to our website or call our office at 281-633-8600. Thank you.
Dr. J. Michael Bennett serves patients from Houston and surrounding areas from clinics located in Houston, near the Galleria, and in Sugar Land near First Colony Mall. Please call for an appointment or you can book an appointment online by clicking the button at the top of the page.