Range Of Motion And Maneuvers

The six motions of the shoulder girdle are flexion, extension, abduction, adduction, and internal and external rotation.

See Table 15-4, Painful Shoulders (pp. 526-527).

The six motions of the shoulder girdle are flexion, extension, abduction, adduction, and internal and external rotation.

Arm Flexion Rotation Adduction

Watch for smooth, fluid movement as you stand in front of the patient and ask the patient to (1) raise (abduct) the arms to shoulder level (90°) with palms facing down (tests pure glenohumeral motion); (2) raise the arms to a vertical position above the head with the palms facing each other (tests scapulothoracic motion for 60°, and combined glenohumeral and scapulo-thoracic motion during adduction for the final 30°; (3) place both hands behind the neck, with elbows out to the side (tests external rotation and abduction); and (4) place both hands behind the small of the back (tests internal rotation and adduction). (Placing your hand on the shoulder during these movements allows you to detect any crepitus.)

Inability to perform these movements may reflect weakness or soft-tissue changes from bursitis, capsulitis, rotator cuff tears or sprains, or tendinitis.

The examination of the shoulder often requires selective evaluation of the acromioclavicular joint, the subacromial and subdeltoid bursae, the rotator cuff, the bicipital groove and tendon, and the articular capsule and synovial membrane of the glenohumeral joint. Techniques for examining these structures are described on following pages.

Structure

Techniques for Examining the Shoulder

Acromioclavicular Joint Palpate and compare both joints for swelling or tenderness.

Adduct the patient's arm across the chest, sometimes called the "crossover test."

Subacromial and Subdeltoid Bursae

Rotator Cuff

Passively extend the shoulder by lifting the elbow posteriorly. This exposes the bursae anterior to the acromion.

Palpate carefully over the sub-acromial and subdeltoid bursae.

With the patient's arm hanging at the side, palpate the three "SITS" muscles that insert on the greater tuberosity of the humerus. (The fourth muscle, the subscapularis, inserts anteriorly and is not palpable.)

■ Supraspinatus—directly under the acromion

■ Infraspinatus—posterior to supraspinatus

■ Teres minor—posterior and inferior to the supraspinatus

Passively extend the shoulder by liftmg Subacromia| bursa s the elbow posteriorly. This maneuver also moves the rotator cuff out from under the acromion. Palpate the rounded SITS muscle insertions near the greater tuberosity of the humerus.

Localized tenderness or pain with adduction suggests inflammation or arthritis of the acromioclavicular joint. See Table 15-4, Painful Shoulders (pp. 526-527).

Localized tenderness arises from subacromial or subdeltoid bursitis, degenerative changes or calcific deposits in the rotator cuff.

Swelling suggests a bursal tear with communication into the articular cavity.

Tenderness over the "SITS" muscle insertions and inability to lift the arm above shoulder level are seen in sprains, tears, and tendon rupture of the rotator cuff, most commonly the supraspinatus. See Table 15-4, Painful Shoulders (pp. 526-527).

Structure

Techniques for Examining the Shoulder

Bicipital Groove and Tendon

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