Shoulder Exam Checklist

Learn about the shoulder and its functions in this guide. Download a free Shoulder Exam Checklist for your practice.

By Ericka Pingol on Jul 15, 2024.

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Fact Checked by RJ Gumban.

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Understanding the shoulder and its functions

The shoulder, as one of the most flexible joints in the body, plays an integral role in the movement and function of the upper limb. It comprises three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). These bones interact at four joints - the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic joints. Each joint contributes to the overall stability and mobility of the shoulder.

Here is the breakdown of each joint and their functions:

  • Sternoclavicular joint connects the clavicle to the sternum (breastbone). It allows for small movement, mainly in rotation and elevation/depression (AAOS, n.d.)
  • Acromioclavicular joint: Located on the outer side of the shoulder, this joint connects the acromion (part of the scapula) to the clavicle (NCBI, 2018). It is responsible for most of the shoulder's upward movement, particularly when lifting the arm above the head.
  • Glenohumeral joint: Also known as the shoulder joint, this ball-and-socket joint connects the humerus and glenoid (part of the scapula). It provides a significant range of motion, allowing for flexion, extension, abduction, adduction, and rotation (NCBI, 2019a).
  • Scapulothoracic joint: This is not a true joint but rather an interaction between the scapula and the thorax (ribcage) (NCBI, 2019b). Together with the glenohumeral joint, it allows for complex shoulder movements and provides stability.

Together, these joints work in harmony to allow for complex movements such as reaching, lifting, throwing, and pushing while providing support and stability to the upper limb. Keeping these joints healthy and functioning properly is crucial for maintaining overall shoulder health and preventing injuries.

Common causes of shoulder pain

There can be various causes of shoulder pain, including injuries, overuse, and medical conditions. Here are some common causes that may affect the shoulder joint:

Rotator cuff injuries

The rotator cuff is a group of muscles and tendons crucial in stabilizing and facilitating shoulder joint movement. These structures work together to support and control the intricate movements of the shoulder, allowing for a wide range of motion. Injuries to the rotator cuff can result from repetitive movements (Mayo Clinic, n.d.), such as those performed in sports or certain occupations, as well as from sudden trauma or accidents.

Shoulder impingement syndrome

This condition, known as shoulder impingement, happens when the space between the top of the humerus and the acromion (a bone in the shoulder) narrows (NCBI, n.d.). As a result, the tendons of the rotator cuff can become irritated or damaged, leading to pain and limited shoulder mobility. It is often caused by repetitive overhead movements or poor posture and can be effectively managed through physical therapy, exercises, and lifestyle modifications.

Frozen shoulder

Also known as adhesive capsulitis, frozen shoulder is a condition that causes significant stiffness and pain in the shoulder joint. It occurs when the connective tissues surrounding the shoulder joint become inflamed and thickened, leading to a limited range of motion (Johns Hopkins Medicine, n.d.). This condition can be caused by various factors such as injury, lack of use, or underlying medical conditions like diabetes or thyroid disorders.

Shoulder dislocation

Shoulder dislocation, or glenohumeral dislocation, is where the humerus bone is forcefully displaced from its socket in the scapula (AAOS, n.d.). This traumatic injury commonly occurs as a result of a fall or a direct impact on the shoulder, causing significant pain and instability in the affected joint.

Arthritis

Various types of arthritis can affect the shoulder joint, leading to pain, stiffness, and reduced range of motion. Osteoarthritis, the most common form, occurs when the protective cartilage cushions the joints and wears down over time (AAOS, n.d.). Rheumatoid arthritis, on the other hand, is an autoimmune condition where the body's immune system mistakenly attacks the joints, causing inflammation.

Shoulder bursitis

Bursae, small fluid-filled sacs in the shoulder, serve as cushions for the tendons, allowing smooth movement and reducing friction (Mayo Clinic, n.d.). However, when these sacs become inflamed, a condition known as bursitis can lead to pain, discomfort, and a limited range of motion in the affected area.

Cervical spine issue

Problems that arise in the neck or upper spine have the potential to radiate pain to the shoulder region. This can occur due to nerve impingement or muscle tension, causing discomfort and limited mobility in the affected area (Mayo Clinic, n.d.).

What is assessed in a shoulder examination?

During a shoulder exam, healthcare professionals will assess various aspects of the shoulder joint to identify any issues or injuries. Some common things that are assessed include:

  • Range of motion: This involves checking the ability to move the arm in different directions, including forward flexion, abduction, internal rotation, and external rotation.
  • Strength: The strength of the rotator cuff muscles is evaluated through various resistance exercises.
  • Palpation: The healthcare professional may use their hands to feel for any tenderness, swelling, or deformities in the shoulder joint.
  • Joint temperature: The affected shoulder may feel warm to the touch, indicating inflammation or infection.
  • Special tests: These maneuvers can help identify specific conditions, such as rotator cuff tears or impingement. Examples include the painful arc, apprehension, and scarf tests.

How does this Shoulder Exam Checklist work?

Our free Shoulder Examination Checklist template lets you stay on top of your patient's shoulder exam. It includes all the important points that must be assessed during a shoulder examination, ensuring no crucial information is missed. Follow the steps below to use the form:

Step 1: Download the template

Access the Shoulder Exam Checklist using the link on this page. You can also Download it from the Carepatron app or our resources library.

Step 2: Use the digital format or print copies

You can use the digital form to fill in the information on your computer or device or print out multiple copies for each patient encounter.

Step 3: Complete the exam and jot down your findings

During the shoulder exam, use the checklist to guide your assessment and make notes of any findings or abnormalities.

Step 4: Share results with the patient

After completing the exam, review the findings with the patient and explain any concerns or recommended next steps.

Other tests to evaluate the shoulder

Several other tests can help diagnose and evaluate shoulder conditions, each designed to assess different aspects of shoulder health. Here are some of them:

Painful arc test

This test involves raising the patient's arm sideways and upwards. A positive painful arc test typically manifests as pain between 60 and 120 degrees of movement, indicating potential rotator cuff pathology.

Contralateral shoulder test

The patient is asked to reach their opposite shoulder by moving their hand across their body. Difficulty or pain during this movement can suggest acromioclavicular joint disease.

Apprehension test

This test assesses for shoulder instability. With the elbow flexed, the examiner externally rotates the patient's shoulder. A positive test is when the patient shows apprehension or resists further movement, indicating a possible history of shoulder dislocation.

Scarf test

The patient brings their hand to the opposite shoulder, mimicking putting on a scarf. Pain or restriction during this test may indicate acromioclavicular joint pathology.

Shoulder range of motion test

The shoulder range of motion test evaluates the degree of motion in different directions, including flexion, extension, abduction, adduction, and internal and external rotation.

Shoulder abduction test

To perform the shoulder abduction test, the patient stands with their arms at their sides. The examiner then raises both arms to 90 degrees and asks the patient to maintain this position for 30 seconds. Any pain or difficulty holding the position may suggest rotator cuff pathology.

References

American Academy of Orthopaedic Surgeons. (n.d.). Sternoclavicular (SC) Joint Disorders. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/sternoclavicular-sc-joint-disorders/

Johns Hopkins Medicine. (n.d.). Frozen shoulder. Johns Hopkins Medicine Health Library. https://www.hopkinsmedicine.org/health/conditions-and-diseases/frozen-shoulder

Mayo Clinic. (n.d.). Rotator cuff injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225

National Center for Biotechnology Information. (n.d.). Shoulder impingement syndrome. Ihttps://www.ncbi.nlm.nih.gov/books/NBK554518/

National Center for Biotechnology Information. (2018). Sternoclavicular joint injuries. Ihttps://www.ncbi.nlm.nih.gov/books/NBK499858/

National Center for Biotechnology Information. (2019). Sternoclavicular joint infections. https://www.ncbi.nlm.nih.gov/books/NBK536933/

National Center for Biotechnology Information. (2019). Sternoclavicular joint septic arthritis. https://www.ncbi.nlm.nih.gov/books/NBK537258/

What should a complete shoulder examination include?
What should a complete shoulder examination include?

Commonly asked questions

What should a complete shoulder examination include?

A complete shoulder examination should include a review of the patient's medical history, observation of the affected shoulder's appearance and movement, palpation to identify any areas of tenderness or swelling, and specific tests to assess range of motion, strength, stability, and potential joint pathology. It is essential also to consider any associated factors such as neck pain or previous shoulder surgeries.

How do you perform a shoulder assessment?

To perform a shoulder assessment, ask the patient about their medical history and any current or previous complaints related to the affected shoulder. Observe the appearance and movement of the shoulder, looking for any deformities, asymmetry, or restricted motion. Palpate the shoulder to identify any areas of tenderness or swelling.

When should I use a Shoulder Exam Checklist?

You can use a Shoulder Exam Checklist when performing a shoulder examination to ensure you cover all aspects of the assessment and don't miss any important information. It can also be useful for documenting and tracking changes in patient conditions.

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