Clinicians find the shoulder difficult to examine for several reasons:
- It has multiple complex parts, including the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic articulation.
- Many of the pathologic processes that affect the shoulder are poorly understood. For example, although rotator cuff disease has been thought to result from impingement of the rotator cuff on the acromion, many studies now suggest that senescence of the tendon is a more important factor and that impingement against bone spurs may not play as large a role.1-3 In addition, pain elicited during a shoulder examination that once was thought to be caused by tendons hitting spurs may instead result from tendons impinging against the superior glenoid rim.1,2,4
- Access to the affected area is restricted because of soft tissue coverage of the glenohumeral joint (by the deltoid and other muscles). Although palpation of the acromioclavicular joint is relatively easy, accurate palpation of rotator cuff tears or the biceps tendon is nearly impossible.
- Pain patterns related to various conditions can overlap and not be specific for any one entity. For example, although pain in the deltoid or proximal humerus may result from rotator cuff problems, it also may be caused by stiffness, cervical radiculopathy, arthritis, and numerous other conditions.
- Because many shoulder tests are sensitive for detecting abnormalities but are not specific for any one condition, they have less diagnostic value than was once thought (Table).5-7
- A thorough evaluation often is needed to narrow the differential diagnosis and determine proper treatment, because more than one condition may be causing the patient's symptoms.
Our goal here is to help you master the shoulder examination. We review the basics of the examination, and we evaluate emerging concepts in the diagnosis of the more common shoulder conditions.
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21. O'Brien SJ, Pagnani MJ, Fealy S, et al. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-613.
22. Stein BE, Wiater JM, Pfaff HC, et al. Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg. 2001;10:204-208.