Shoulder exam

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MRCS Shoulder Examination Outline

1. Introduction

Greet patient, explain procedure.

Ensure privacy and adequate exposure of the shoulder.

Ask about pain, weakness, or functional limitations.

Obtain consent.

2. Inspection

General: posture, muscle wasting, asymmetry.

Deformities: swelling, bruising, scars.

Specific signs: scapular winging, acromioclavicular prominence.

3. Palpation

Bones: clavicle, acromion, acromioclavicular joint, coracoid process, humeral head.

Soft tissues: rotator cuff tendons, biceps tendon, deltoid.

Tenderness: localized or diffuse.

4. 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.

5. 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.

6. Strength Testing

Test deltoid, supraspinatus, infraspinatus, subscapularis, biceps.

Compare bilaterally.

7. Neurovascular Examination

Peripheral nerves: axillary, musculocutaneous.

Vascular: radial pulse, capillary refill.

8. 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.