The regional musculoskeletal examination (RMSE) of the shoulder is designed to build on the sequences and techniques taught in the SMSE and GMSE. It is intended to provide a comprehensive assessment of structure and function combined with special testing to permit you to evaluate common, important musculoskeletal problems of the shoulder seen in an ambulatory setting. The skills involved require practice and careful attention to technique. However, they can be learned and mastered on normal individuals.
The RMSE of the shoulder is clinically useful as the initial examination in individuals whose history clearly suggests an isolated shoulder problem. In individuals whose history is less straightforward (a seemingly local shoulder problem with additional musculoskeletal complaints of unclear relevance), a rapid SMSE may be the most appropriate first step in physical assessment. If significant, possibly related, abnormalities are found (and the patient's presenting shoulder complaint appears to be part of a more generalized musculoskeletal process), then performing a GMSE would be most appropriate.
With practice, a systematic, efficient RMSE of the shoulder can be performed in ∼3 to 4 minutes.
Furthermore, the RMSE of the shoulder provides the foundation for learning additional, more refined diagnostic techniques through your later exposure to orthopedic surgeons, rheumatologists, physiatrists, physical therapists, and others specifically involved in the diagnosis and treatment of shoulder problems.
This instructional program will enable you to identify important anatomic, functional, and pathologic relationships at the shoulder, including:
- Cervical spine ROM
- Sternoclavicular (SC) joint
- Acromioclavicular (AC) joint
- Subacromial bursa, rotator cuff, and biceps tendons
- Impingement testing
- Glenohumeral (GH) joint ROM
Most importantly, it will prepare you to perform an organized, integrated, and clinically useful regional examination of the shoulder.
Structural and Functional Anatomy
The scapula is a thin, flat bone that serves as the attachment for muscles of the shoulder (rotator cuff, deltoid, and others), articulates with the chest wall at the scapulothoracic joint and the clavicle at the AC joint, and provides the shallow socket for the humeral head, the glenoid fossa (Fig. 4–1).
In addition, the scapula provides the superior, protective bony “roof” of the shoulder joint, the acromion (Fig. 4–2) and an anterior hook-like projection for the attachment of tendons and ligaments, the coracoid (Fig. 4–3).
The GH joint, rather than a ball and socket like the hip, can better be likened to a “golf ball” (humeral head) on a “golf tee” (glenoid) (Fig. 4–4). This shallow socket permits a significant range of motion at the expense of stability. A ring ...