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What is it about ?
The shoulder is the most mobile joint in the body. This mobility is ensured by the joint work of 3 joints and a whole series of muscles, in particular the rotator cuff, a muscle group that strengthens the stability of the shoulder joint and takes charge of shoulder movements around 3 axes, namely outward, sideward / upward and inward.
What does the basic shoulder exam consist of?
The shoulder is still examined shirtless. Each therapist has their own routine, the basic exams listed below do not always take place in the same order. It is important that all aspects of the shoulder exam are covered.
Usually the therapist begins with a neck and shoulder observation:
- Loss of muscle mass (muscle atrophy) behind the scapula could mean nerve or tendon damage
- A slight swelling in a joint could suggest a joint problem.
The therapist will also check by palpation if the tendons are tender or painful to see if they are showing inflammation (tendinopathy).
The mobility of the shoulder joint is checked through an active and passive examination:
During the active exam, the doctor will ask you to move your arm in different directions:
- In front of you (flexion);
- Behind you (extension);
- Move it away from your body (abduction);
- Bring it closer to your body (adduction);
- Keeping your elbow close to your body, bring your hand to your stomach (internal rotation);
- Keeping your elbow to your body, move your hand away from your stomach (external rotation).
He will thus check whether the movements are complete and / or painful and will look for a possible painful arch.
During the passive examination, the therapist performs these different movements himself, while you relax completely. Each movement is performed as completely as possible, without the muscles exerting any force. Pain and limitation of movement may suggest damage to certain non-elastic internal structures such as, for example, the joint capsule.
The therapist will also test the strength developed by your shoulder muscles. During this examination, you should exert maximum force on your own in all directions, while the doctor restrains or prevents the movement. Pain or limitation in strength indicates damage to an elastic structure, such as muscles and tendons.
If the shoulder is unstable, the therapist can test the joint between the scapula and the collarbone for proper functioning by asking you to lift your shoulders. If the shoulder is unstable, the shoulder joints are too mobile and the shoulder tends to move outside the normal limits of mobility. It can go forward (anterior instability), backward (posterior instability) or down (inferior instability); the following tests make it possible to examine these cases:
- Drawer test: The therapist moves the head of the humerus forward and backward as he stabilizes the scapula with his other hand. If he feels an increase in mobility, this indicates anterior and posterior instability
- Apprehension test: you feel a sensation of discomfort in your shoulder when it is moved sideways 90 °, then turned outwards. This feeling goes away when the doctor puts back pressure on the head of the humerus. This suggests previous instability.
- Sign of the groove: the doctor pulls the relaxed arm down. A visible space between the head of the humerus and the acromion (the bone that borders the shoulder) indicates inferior instability.
Want to know more?
- Shoulder bones (image) – Larousse
- Shoulder: a joint to be spared – mongeneraliste.be – SSMG – Scientific Society of General Medicine
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