MRCS Shoulder Examination Outline
Introduction
Greet patient, explain procedure.
Ensure privacy and adequate exposure of the shoulder.
Ask about pain, weakness, or functional limitations.
Obtain consent.
Inspection
General: posture, muscle wasting, asymmetry.
Deformities: swelling, bruising, scars.
Specific signs: scapular winging, acromioclavicular prominence.
Palpation
Bones: clavicle, acromion, acromioclavicular joint, coracoid process, humeral head.
Soft tissues: rotator cuff tendons, biceps tendon, deltoid.
Tenderness: localized or diffuse.
Range of Motion (ROM)
Active ROM: flexion, extension, abduction, adduction, internal rotation, external rotation.
Passive ROM: repeat movements to assess joint limitation.
Look for pain, crepitus, or weakness.
Special Tests
Impingement:
Neer’s test – checks for subacromial impingement (YES, included).
Hawkins-Kennedy – alternative impingement test.
Labral/SLAP lesions:
O’Brien’s test (active compression test) – checks for SLAP tears (YES, included if SLAP suspicion).
Rotator cuff:
Empty can (supraspinatus), external rotation resistance (infraspinatus), lift-off (subscapularis).
Instability:
Apprehension, relocation tests.
AC joint:
Cross-body adduction test.
Strength Testing
Test deltoid, supraspinatus, infraspinatus, subscapularis, biceps.
Compare bilaterally.
Neurovascular Examination
Peripheral nerves: axillary, musculocutaneous.
Vascular: radial pulse, capillary refill.
Conclusion
Summarize findings to patient.
Wash hands, allow patient to dress.
Neer’s test: included for impingement assessment.
O’Brien’s test: included if evaluating for SLAP or labral pathology; it’s not mandatory in every MRCS exam, but mentioning it shows knowledge of labral assessment.
