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Musculoskeletal complaints account for >20% of outpatient visits and will likely increase as the population ages. Shoulder pain is the third most common musculoskeletal complaint, behind back and knee pain. An efficient shoulder examination is a useful tool to guide diagnosis and treatment, as well as appropriate referrals.
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In terms of functionality, the shoulder joint can be viewed as a sideways golf ball on a tee (Figure 15-1). The primary benefit of the ball-and-socket alignment is that it allows the hand to be positioned precisely in space, maximizing our ability to function within an amazing 360-degree arc. The downside of this wide mobility is a trade-off with shoulder stability, which depends on both static (shoulder joint capsule) and dynamic (rotator cuff muscles) stabilizers to keep the humerus aligned in the joint.
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Because the simple elegance of shoulder anatomy allows a 360-degree arc, the shoulder examination includes testing in multiple planes, so the sheer number of exam maneuvers starts to stack up quickly. We will use a few simple acronyms to organize our shoulder exam into diagnostic categories. A little organization goes a long way toward mastering a quick and efficient diagnosis-driven shoulder evaluation. Note that this exam is typically performed only when patients have shoulder pain and/or impaired function. The core components of the exam are provided in Table 15-1.
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A caveat: The shoulder examination presented in this chapter is geared toward the initial evaluation and diagnosis of common causes of shoulder pain. Additional tests targeting less common shoulder diagnoses can be added to your exam skills if you enter a specialty field like sports medicine or orthopedics.
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The shoulder joint is created by the confluence of 3 bony structures: the scapula, humerus, and clavicle (Figure 15-2). These are held together by ligaments and an intricate web of muscles. We will review shoulder anatomy as we learn the exam—namely, anatomy of pertinent bony prominences for observation/palpation and the detailed anatomy of the rotator cuff muscles for range-of-motion (ROM) and strength exams.
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