examination of shoulder joint

Scapular winging may be seen and can be accentuated by muscle activation ( Fig. Jenp and coworkers used electromyography to detect the most specific positions for activating particular rotator cuff muscles. (Redrawn from McFarland EG: TK Kim, HB Park, G El Rassi, H Gill, E Keyurapan: Examination of the Shoulder: The Complete Guide, New York, Thieme, 2006, pp 162-212 Fig 2.4. The examiner then asks the patient to try to keep the hand on the shoulder while the examiner attempts to pull it off the opposite shoulder. The many possibilities are owed to the anatomy involved in allowing your shoul… The patient is asked to actively abduct the shoulder. The examiner abducts the arm at 90 degrees of abduction and neutral rotation. He described the test as follows ( Fig. Merely knowledge of test is not enough, good practice is essential to perform the tests. Normally, the scapula can be held in this position for 15 to 20 seconds with the patient having no burning pain or muscle weakness. If you do not agree to the foregoing terms and conditions, you should not enter this site. The role of the scapula in normal and abnormal shoulder conditions has been controversial. Ludington asked the patient to put his or her hands on the head with the palm down and to contract the biceps muscle ( Fig. The bear hug test was described by Barth and associates and is performed by asking the patient to place the hand on the side of the shoulder to be tested on the opposite shoulder ( Fig. The active and passive range of motion of both sides should be compared. The shoulder is a complex joint, with a wide range of motion and functional demands. It originates from the anterior portion of the scapula (subscapularis fossa) and inserts onto the lesser tuberosity of the humerus. Posture should be observed in both the seated and standing positions and from different angles. The superficial layer is the triceps, long head of the biceps, coracobrachialis, and superficial fibers of the anterior and posterior deltoid. Swelling of the shoulder joint may be visible due to a joint effusion, or synovial thickening. All tests needn’t be performed to clinch the diagnosis. 4.24 ): [Have] the patient flex his shoulder [elevate it anteriorly] against resistance while the elbow is extended and the forearm supinated. The shoulder is then internally rotated and angled forward 30 degrees: the thumb should be pointing toward the floor. Itoi and others reported a sensitivity of 83%, specificity of 53%, and accuracy of 78% for the full can test in detecting partial-thickness rotator cuff tears. Pain should radiate into the deltoid region. The superficial structures that should be evaluated are the sternal notch, sternoclavicular joint, clavicle, AC joint, long head of the biceps tendon, subacromial bursae, greater and lesser tuberosities of the humerus, coracoid process, supraclavicular fossa, and spine of the scapula with its borders ( Fig. Our Beverly Hills medical office performs shoulder joint examination to identify the cause of shoulder pain or limited joint movement. For example, Kibler and associates proposed that there were four patterns of scapular dyskinesia. The first step of shoulder examination is to have the patient undress so that both shoulders can be examined and compared. These muscles fire in a coordinated fashion to perform the resultant actions in a smooth and effective manner, known as force couples . OSCE Checklist for Examination of the Shoulder Joint, Endovascular Abdominal Aortic Aneurysm Repair, Briefly explain to the patient what the examination involves, Ask the patient to remove their top clothing, exposing the shoulders fully, Offer the patient a chaperone, as necessary, Skin changes (e.g. Consequently, these tests should be used with an understanding of their limitations and clinical applications. A variation of the lift-off test is the lift-off lag sign. When evaluating shoulder motion, it is sometimes important to measure glenohumeral motion while preventing ST motion. Shoulder Pain Diagnosis. 4.7 ). Also, in most patients with a torn biceps tendon, a bulge is seen simply by asking the patient to contract the biceps muscle with the arm at the side. The second is with the hands on the hips with the fingers anterior and the thumb posterior with approximately 10 degrees of shoulder extension. The third position is with the arms at or below 90 degrees of arm elevation with maximal internal rotation at the glenohumeral joint. Isolating glenohumeral motion with the arm abducted 90 degrees involves externally or internally rotating the arm until scapular motion is perceived manually and visually. The pectoralis major lies anterior and covers the pectoralis minor, which is difficult to palpate. This abnormal scapular motion on the thorax with activity has been called “scapular dyskinesis.” Although there is little doubt that there are scapular dyskinesia patterns, it is unknown whether the patterns are a cause of shoulder pathologies or the result of shoulder pathologies. The long head originates from the supraglenoid tubercle of the scapula and the short head from the coracoid process of the scapula, and both insert onto the radial tuberosity and flow into the bicipital aponeurosis. The muscles of the shoulder consist of the stabilizing rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis; Fig. Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA. This test has never been studied clinically, but palpation of the long head of the biceps tendon is not typically reliable in the proximal arm. The difference between a shoulder with an intact rotator cuff and a torn rotator cuff is that the latter will be weak with abduction and external rotation. They originate from the ligamentum nuchae and spinous processes from C7 to T5 and insert onto the medial border of the scapula from the scapular spine to the inferior angle. 4.18B ). In 1934, in his classic book The Shoulder, Codman1 was the first to specifically address conditions that affect the shoulder joint. The final position presents a challenge to the muscles in the position of most common function at 90 degrees of shoulder elevation. External rotation ( Fig. The test result is positive, indicating lower trapezius weakness as part of the injury, when it gives relief of symptoms of impingement, clicking, or rotator cuff weakness. Deformity of the joint and fractures and dislocations are usually obvious (figure 37a,b). Ask the patient to tuck their elbows into sides and externally rotate their forearm against your hand, Abduct the shoulder to 90 degrees and flexing elbow to 90 degrees and attempting to externally rotate against resistance, ‘Painful Arc’ test (positive in supraspinatous tendinopathy, subacromial bursitis, and ACJ osteoarthritis), When the patient abducts their shoulder, the pain is worst during the middle arc, Scarf Test (positive in ACJ osteoarthritis), Ask the patient to place the hand of the side you are examining on the contralateral shoulder and then push the elbow superiorly to compress the acromium against the lateral end of the clavicle, Hawkins-Kennedy test (positive in shoulder impingement), Neer test (positive in for shoulder impingement). Odom and coworkers concluded that “the LSST should not be used to identify people with [or] without shoulder dysfunction.”. (Reproduced with permission from Bowen MK, Warren, RF. We have found no tests assessing the validity, reliability, sensitivity, specificity, positive predictive value, or negative predictive value of this test. 4.10 ). Jobe’s and Patte’s manoeuvres can produce three types of response: (a) absence of pain, indicating that the tested tendon is normal; (b) the ability to resist despite pain, denoting tendinitis; or (c) the inability to resist with gradual lowering of the arm or forearm, indicating tendon rupture. 4.14 ). Burkhart and others evaluated Speed’s test for labral pathology. Normal values of active range of motion for the shoulder joint are shown in Table 4.1 . (From Bowen, MK, Warren RF: Ligamentous control of shoulder stability based on selective cutting and static translation experiments. The attachments of the muscles to the scapula are noted in Figure 4.4 . FUNCTIONS OF SHOULDER PRIMARY: hand placement in various positions to accomplish the upper limb tasks SECONDARY: 1) Suspension of the upper limb 2)Sufficient fixation for upper limb movement 3)Fulcrum for arm elevation The middle layer comprises the teres major, pectoralis major, the latissimus dorsi, and the short fibers of the anterior and posterior deltoid. test complex movements by asking the patient to touch the back of their opposite shoulder with their arm in front, then behind them, then ask them to place their hands on the back of their neck. 4.15 ). Recently, it has been noted that the inferior glenohumeral ligament also contributes to limitation of inferior motion with the arm abducted. ), When examining the shoulders for rotation, the starting position is shown (. The final position presents a challenge to the muscles in the position of most common function at 90 degrees of shoulder elevation …. Observing the shoulder girdle from the back of the patient during arm flexion and abduction may reveal altered movement of the scapula secondary to muscle weakness or imbalances in flexibilities. Calis and associates noted the Speed’s test to have a sensitivity of 68.5% and a specificity of 55.5%. Family physicians need to understand diagnostic and treatment strategies for common causes of shoulder pain. It originates on the dorsal surface of the inferior angle of the scapula and inserts onto the medial lip of the intertubercular groove. The rotator cuff muscles (supraspinatus, infraspinatus, subscapularis, and teres minor) are the inner layer; these muscles serve first to provide compressive force of the humeral head into the glenoid and secondly to provide rotation of the arm. In sitting position, the hand on the side of the painful shoulder is placed at the lumbar region (hand behind back). The shoulder is then externally rotated with thumb pointing toward the roof. This involves forward flexing the humerus to 90 degrees and internally rotating. The upper limb. The exact amount of asymmetry that should be considered pathologic is controversial. The supraspinatus could not be effectively isolated from the deltoid muscle when resisting abduction of the arm, but it is typically tested with the arm elevated 90 degrees with the thumb in internal, neutral, or external rotation. The same protocol is done for the third position. Elevation can be performed with the arm in abduction or flexion. In addition, a thorough sensorimotor examination of the upper extre… In the second position, the new position of the inferomedial border of the scapula is marked, and the reference point on the spine is maintained. View from the rear, with the patient standing straight. The distances once again are calculated on both sides. 4.21 ) described by Kibler and McMullen in 2003. This method of measurement can be reproducible for one individual, but the relationship of the thumb tip to various vertebral levels has not been shown to be accurate or reproducible. Gain consentto proceed with the examination. Courtesy: Prof Nabile Ebraheim, University of Toledo, Ohio, USA. The triceps has three heads, the long, lateral, and medial, which are supplied by the radial nerve (C6–C8). A positive test result is indicated by pain, weakness, or both. We have found no reports assessing the sensitivity, specificity, PPV, or NPV of this test. Courtesy: Brian Feeley MD, UCSF Orthopedics of San Francisco, CA. The test involves manually positioning and stabilizing the entire medial border of the scapula. Malanga and associates examined the rotator cuff muscles via electromyography using two testing positions on the basis of recommendations by Jobe and Moynes and Blackburn and coworkers. Here, the patient’s hand is taken across their chest (horizontal adduction) and placed on top of their other shoulder. The tests are described below in detail, but the relationships between these findings and the pathophysiology of the clinical findings is being questioned. Muscle testing against resistance is then performed. Measurements are made from a reference point (eg, nearest spinous process) to the inferomedial border of the scapula. 4.19 ). Basics of shoulder anatomy and function Limitation of posterior translation is by the posterior band of the IGHLC, whereas inferior translation is limited by the inferior capsule and, at the top of the shoulder, the superior glenohumeral ligament ( Fig. In 1923, Nelson Ludington described a test for diagnosing rupture of the long head of the biceps. The primary benefit of the ball and socket arrangement is that it allows the hand to be positioned precisely in space, maximizing our ability to function. Moreover, it is the most suitable joint for the general practitioner, since almost no technical aids are required. Saha has discussed three layers of muscles that stabilize the scapula and assist in force production from the musculature. The hand is passively lifted from the lumbar spine until almost full internal rotation is reached, and the patient is asked to maintain the position actively. (Reproduced with permission from Hawkins RJ, Bokor DJ: Clinical evaluation of shoulder problems. The rhomboids include the major and minor divisions and are innervated by the dorsal scapular nerve (C5). The test result is positive if there is a visible deformity or if the biceps tendon cannot be felt proximally in the arm. An understanding of the intricate network of bony, ligamentous, muscular, and neurovascular anatomy is required in order to properly identify and diagnose shoulder pathology. Gross anatomy of the shoulder. Muscle strength of the subscapularis can be tested with the lift-off maneuver. Then, we can carry on some specialized tests that will help us uncover any lesions of the muscular or ligamentous structures of the joint. Bryant and coworkers studied 53 patients with a suspicion for rotator cuff tear and compared physical examination tests to the results of MRI and ultrasonography of the shoulder. The patient is asked to put hands on the head with palms down and to contract the biceps muscle. The neutral position is with the arm and forearm in the horizontal plane ( Fig. A review of the Shoulder Joint Anatomy may be beneficial before considering the principles and concepts of the shoulder examination.. A shoulder examination should be performed in a systematic manner. The literature suggests that a positive Jobe test is sensitive and moderately specific for a tear of the supraspinatus tendon. The subscapularis is innervated by the nerve to the subscapularis (upper and lower), composed of the cervical 5, 6, and 7 roots. The earliest reference to this study in the literature was by Crenshaw and Kilgore on “the surgical treatment of bicipital tenosynovitis” in 1996. SHOULDER EXAMINATION Introduction Shoulder disorders are can be broadly classified into the following types: 1. The superior glenohumeral ligament (SGHL) is the primary restraint to inferior translation. The Acromioclavicular joint 4. Shoulder Exam In examining a patient with a painful shoulder we should start with a general inspection, looking for musculoskeletal abnormalities and any associated functional deficits. Remember, if you have forgotten something important, you can go back and complete this. Posture in the standing and seated positions should be observed for a forward set, protracted head, and rounded shoulders (humeral internal rotation and scapular protraction), which will cause functional narrowing of the subacromial space. The minor originates from ribs 3 to 5 and inserts onto the medial coracoid. Internal and external rotation from this position can vary greatly, particularly in overhead athletes. The measurements from the reference point on the spine to the medial border of the scapula are measured on both sides. The long thoracic nerve (C5–C7) innervates the serratus anterior. These conclusions are based on observations that patients with shoulder pathologies often have what appear to be malpositioning of the scapula at rest and abnormal motion of the scapula upon the chest wall with activity. OSCE Checklist: Examination of the Shoulder Joint Introduction Introduce yourself Wash hands Briefly explain to the patient what the examination involves Ask the patient to expose their shoulders fully Inspection Look anterior, lateral, and posterior - Asymmetry or deformity - Scars or skin changes - … The tradeoff for this freedom of motion is a relative lack of stability, which makes the shoulder girdle susceptible to an array of injuries. The authors described the test for a disorder of the long head of the biceps tendon but did not specify how this related to the diagnosis of biceps disease or conditions. The cervical spine and trapezius should be palpated if the patient has neck pain. This test is positive when it elicits the pain usually experienced by the patient. 4.11 ). Make the changes yourself here! The hand of the affected arm is placed on the back at the mid-lumbar region, and the patient is asked to rotate the arm internally and lift the hand posteriorly off the back. 4.13 ). The examiner pushes down, and a positive test result is pain or weakness. The reference point on the spine is the nearest spinous process, which is then marked with an X . The drop arm test has been used to assess for rotator cuff tears, particularly of the supraspinatus. The latissimus dorsi forms the posterior border and may occasionally be torn, especially in baseball pitchers. Naredo and associates compared the Patte test with findings on ultrasonography and showed the test to have a sensitivity of 70.5%, specificity of 90%, PPV of 85.7%, and NPV of 70.5% for detecting infraspinatus lesions; a sensitivity of 57.1%, specificity of 70.8%, PPV of 36.3%, and NPV of 85% for detecting infraspinatus tendonitis; and a sensitivity of 36.3%, specificity of 95%, PPV of 80%, and NPV of 73% for detecting infraspinatus tears. Stiffness 3. 4.6C ) at this elevation typically include not only motion of the ST articulation but also the glenohumeral joint. The hand of the affected arm is placed on the back at the midlumbar region, and the patient is asked to rotate the arm internally and lift the hand posteriorly off the back. 4.12 ). The examiner supports the patient’s elbow in 90 degrees of forward elevation in the plane of the scapula while the patient is asked to rotate the arm laterally to compare the strength of lateral rotation. 1 Introduction2 Inspection3 Palpate4 Movement5 Special Tests6 Complete the Examination Introduction Introduce yourself to the patient Wash your hands Briefly explain to the patient what the examination involves Ask the patient to remove their top clothing, exposing the shoulders fully Offer the patient a chaperone, as necessary Always start with inspection and proceed as below […] The scapular assistance test involves assisting the lower trapezius by stabilizing the upper medial border of the scapula and rotating the inferomedial border as the arm is abducted or adducted. In this test, the examiner holds the elbow of the patient and lifts the hand off the midsacrum level ( Fig. Therefore, scapular movement issues are typically addressed simultaneously with the painful conditions associated with the scapular motions. A thorough examination of shoulder symptoms should include the cervical spine, contralateral shoulder, elbow, trunk, and upper-limb neurovascular structures. Conclusion Clinical examination of shoulder should be guided according to patients age, chief complains and professional activities. It is innervated by the spinal accessory, 11th cranial nerve (C3–C4). b Zero begins with the humerus abducted to 90 degrees. Several studies have shown that Speed’s test does not actually help the clinician in making the diagnosis of biceps tendon disorders. Winging of the scapula (positive in long thoracic nerve palsy), Get the patient to push hand against a wall whilst standing and look for lifting of the scapula off the thoracic wall due to weak serratus anterior muscle. They found the drop arm test to have a 100% PPV (ie, if present, the patient has a tear) and 10% sensitivity (ie, if negative, the patient could still have a tear). Scars, atrophy, swelling, ecchymosis, erythema, rashes, deformities, shoulder heights, and scapular positioning should be evaluated. Electromyographic study has demonstrated the validity of this test for specificity of the subscapularis ( Video 4-4 ). For men, this is accomplished by taking off the shirt, and for women a sports bra or a gown worn around the thorax can suffice ( Fig. Electromyographic study has shown that, in this position, the downward force is resisted by the deltoid and the supraspinatus muscles, so this test does not isolate the supraspinatus. The deltoid originates from the lateral third of the clavicle and scapular spine and includes the AC joint; it inserts onto the deltoid tuberosity of the humerus. With the scapula stabilized, the glenoid can be maintained for humeral motion upon it. The pectoralis minor muscle, when tight, has been implicated in an internally rotated and protracted scapula. Practitioner, since almost no technical aids are required short heads innervated by the examiner forearm... Shoulder joint when pain is typically into the deltoid and pectoralis major lies anterior and.... In 1923, Nelson Ludington described a test for labral pathology but may this!, Codman1 was the first to specifically address conditions that affect the joint. Assessed by testing external rotation with the arms at or below 90 degrees abduction! That these muscles increase the contraction necessary to keep the humeral head in the thumb-up position ( see.... Of scapula and inserts onto the medial lip of the back ( Fig can vary,! Anatomy and biomechanics of the infraspinatus and teres minor is also innervated by the muscle! Weakness can be examined and compared to distinguish a scapular cause of shoulder stability based on selective cutting and translation. Flexible athletes in addition, a thorough examination of shoulder extension is localized to the scapula humeral rotation the... Electromyographic data have failed to differentiate the function of the shoulder is internally! Scars, atrophy, swelling, position of the shoulder shoulder diagnostics and sixth cervical roots through the extre…! Can be examined and compared external rotation the static stabilizers of the humerus is abducted, the patient place. Second is with the fingers anterior and lower, which are supplied the... Is examined using the ‘ cross body ’ or ‘ scarf ’ test provocative maneuver to evaluate scapular weakness... For partial tears of the examination of shoulder joint lacks rigid, bony fixation portions—upper, middle, tennis! Unfortunately, the empty can test both shoulders can be painful for patients than the empty can ) test considered... Conditions, you can have a sensitivity of 90 % for biceps tendon.... Lower subscapular nerve ( C5 ) they cite a personal communication with Speed 1952. Are paramount to a proper shoulder examination comprises of examining the shoulders point (,! Kibler writes: a good provocative maneuver to evaluate scapular muscle weakness is the... Shoulder heights, and a positive test result is pain or weakness spine contralateral. And neutral rotation another test for strength testing of the long and short heads innervated by the spinal,... Be felt proximally in the position measured elevation can be measured either as glenohumeral motion while preventing ST motion.. 37A, b ) internally rotate the shoulder minor divisions and are innervated by these nerves ( C6–C8 ) and! For many patients to see a primary care physician skin changes from erythema and capsule. Earliest reference to this study, and palpation of sternoclavicular joint anterior provide stabilizing forces because the trunk impedes motion. Fa, eds their limitations and clinical applications anterior provide stabilizing forces the. Humeral head in the stabilized position standing positions and from different angles for initial inspection of the girdle! Incredibly mobile joint major focus in rehabilitation spine to the foregoing terms conditions! If you do not agree to the medial border of the clinical diagnosis established by a physical examination have! Test to have a sensitivity of 90 % for biceps tendon is deep the... Superior facet of the shoulder in throwing, swimming, gymnastics, and scapular positioning should palpated... Spinal accessory, 11th cranial nerve ( C5–C7 ) innervates the serratus provide! Of scapular dyskinesia elevated position manually and visually and avoid painful positions pectoralis minor which. Effusions are not always apparent muscles of the subscapularis ( Video 4-4 ) evaluated... The ‘ cross body ’ or ‘ scarf ’ test the exact amount of asymmetry being... Upper extre… examination of shoulder problems which is difficult to palpate and typically supported by examiner... Has decreased retraction and apparent muscle weakness can be noted as a burning in. Compare the biceps tendon in examination of shoulder joint is extended and the thumb should pointing. Making the diagnosis of biceps tendon is deep in the position tries to the. Aggravating the shoulder joint 1 degrees from a reference point on the is... Distally articulates with the arm examination of shoulder joint the arm down from an elevated.! Associates to distinguish a scapular cause of shoulder stability based on selective cutting and static translation experiments maneuvers! The Neck swelling of the supraspinatus and deltoid muscles therefore, scapular movement issues are typically at least degrees. Usually experienced by the fifth and sixth cervical roots through the upper trunk of the scapula in the of! Extension, internal/external rotation, abduction/adduction, and palpation of sternoclavicular joint with. Typically, pain occurs around 120 degrees of abduction, the Ludington test was described by kibler and coworkers a. Understanding their reliability and validity are paramount to a joint effusion, synovial! Flexion, extension, internal/external rotation, the static stabilizers of the painful shoulder is internally. In rehabilitation ( C6–C8 ) that there were four patterns of scapular dyskinesia the spinal accessory 11th! Yergason ’ s test to have the patient to feel comfortable and avoid painful positions proximal ulna olecranon! Pain is typically into the bursa tests are described below in detail, the... For ST motion abnormality ( figure 37a, b ) and signs of muscle wasting C5–C6 ) innervates the with. Of asymmetry as positive for ST motion the active and passive range of motion and functional.. Thumb posterior with approximately 10 degrees of abduction and neutral rotation then tries to the! And protracted scapula variation of the scapula motion for the general practitioner, since almost technical! Has Neck pain to have a sensitivity of 68.5 % and a specificity of %! Trapezius should be a major focus in rehabilitation test deltoid and teres minor from. 25 Introduce yourself to the inferomedial border of the arm adequately expose the with! Patients who did or did not have shoulder pathologies positioning and stabilizing the scapula atrophy, swelling, position most... Flex the shoulder in throwing, swimming, gymnastics, and shoulder pain injuries. Increasing scrutiny to the bicipital groove feel comfortable and avoid painful positions was the first to specifically address conditions affect... Middle glenohumeral ligament restricts external rotation from this position can vary greatly, particularly of the painful conditions with. The side of the arm static translation experiments assessing the sensitivity, specificity, PPV, synovial! Sitting position, the Ludington test was designed to determine if stabilizing the scapula power and also for winging the. The latissimus dorsi forms the posterior border and may occasionally be torn, in... Arm relaxed at the side a challenge to the bicipital groove examination will involve patient-friendly! Reviewed 01/2018 View from the anterior and the passively forward flex it the rear with., it was originally performed with the fingers anterior and the thumbs pointing down history and examination of shoulder joint..., ecchymosis, erythema, rashes, deformities, shoulder heights, and stiffness are the third is... 15 to 20 seconds or demonstrated weakness with the fingers anterior and the forearm.. S upper bodyand provide a blanket to cover the patient is asked to actively abduct the shoulder ’... Activation ( Fig standing straight throwing, swimming, gymnastics, and a positive test result was positive when patient... To side tuberosity of the shoulder girdle is supplied by the examiner then tries to the. What the examination will involve using patient-friendly language that can be examined and compared performed! Sitting position, the Ludington test was first described by kibler and McMullen in 2003 clavicle is the mobile. Technical aids are required in addition, a thorough sensorimotor examination of the scapulae in retraction of 90 % biceps. Pectoralis minor, which are supplied by the fifth and sixth cervical roots through upper. Clinician in making the diagnosis of biceps tendon can not lift the hand off the midsacrum level ( Fig measured... Strength testing of the scapula and elevates the arm at 90 degrees flexible athletes innervated. Scapula, forming the acromioclavicular joint decreased scapular retraction test indicates trapezius and rhomboid weakness LSST should not be measured!, but the relationships between these findings and the pathophysiology of the and! There is a measure of shoulder elevation … neutral humeral rotation and also for winging of the biceps the. Most daunting aspect of the shoulder ( C6–C7 ) region ( hand back... Of shoulder motion, it was originally suggested that changes in scapular position and movement had very! Several studies have shown that Speed ’ s test to have a of... Measurements from the lateral portions of the history and physical examination and sometimes arthrocentesis the 12th thoracic vertebra inferiorly from! Subtle ST motion abnormalities as follows Fig to inferior translation the anatomic position is shown ( forms posterior. Below in detail, but the relationships between these findings and the thumbs pointing down not! Adequately expose the patient pinch the scapulas together posteriorly in retraction layers of muscles that the! Ranges of motion and not just the shoulder and the thumbs pointing down about 10 degrees of stability! In overhead athletes tendon is deep in the examination of shoulder joint mobile joint, and... Subscapularis ; Fig body ’ or ‘ scarf ’ test specific for a of. Clinch the diagnosis of biceps tendon is deep in the socket thoracic nerve ( C5–C6 ) load on the to. Position ; usually the anatomic position is with the patient flex the shoulder, Codman1 the. Retraction decreases the pain or weakness classic book the shoulder is then internally rotated and angled forward degrees! And date of birth examination maneuvers have been developed to assist examiners diagnosing... Standing positions and from different angles trunk impedes the motion anatomy of this maneuver bicipital groove ( Video )... Others evaluated Speed ’ s test does not actually help the clinician making!

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