Orthopaedic examination of any bone or joint follow the same basic structure:

LOOK - gait (if lower limb), erythema, swelling, scars, deformity, muscle wasting

FEEL - warmth, tenderness, swelling, crepitus

MOVE - range of motion, power

SPECIAL TESTS - joint stability, isolated muscle power, provocative tests

JOINT ABOVE & BELOW - ensure pain not radiating from elsewhere

NEUROVASCULAR - examine neurological and vascular supply to limb

This is followed by INVESTIGATIONS - blood tests, X-rays, further imaging

Each section describes a basic technique to examine the joints regularly seen in the exams and clinics. By following the routine described above, most joints can be examined thoroughly. The text does not provide an exhaustive description of every test available but outlines the commonly used basic examinations.

Shoulder

LOOK

Scars - deltopectoral (from coracoid towards axillar), arthroscopy (anterior, posterior and lateral)

Deformity – chronic anterior dislocation (hollow under acromium and fullness anteriorly)

Muscle wasting - deltoid (axillary nerve), trapezius (spinal accessory nerve), supraspinatus (suprascapular nerve), serratus anterior with winging of scapular (long thoracic nerve)

FEEL 

Tenderness - feel full length of clavicle, acromion, glenohumeral joint and scapular spine. Isolated tenderness over acromioclavicular joint (ACJ osteoarthritis)

MOVE 

Range 

1.             abduction 0-170°

2.             flexion 0-180°

3.             extension 0-70°

4.             external rotation 0-80°

5.             internal rotation 0-90°

            Painful arc -  40-150° abduction - impingement syndrome

                                    150-180° abduction - acromioclavicular disease

SPECIAL 

Power - rotator cuff muscles:

                                    Supraspinatus - resisted abduction with thumb point down

                                    Infraspinatus & teres minor - resisted external rotation

                                    Subscapularis - resisted internal rotation

Joint stability - Apprehension test - patient lying at 45°, shoulder abducted 90° and elbow flexed 90°, external rotation of shoulder causes apprehension of anterior dislocation.

Relocation test - apprehension test repeated with hand placed firmly at front of shoulder, blocking anterior instability and preventing apprehension.

Provocative - Empty can test - resisted abduction with thumb pointing towards ground causes pain = subacromial impingement

Scarf test (cross arm adduction) - hand is adducted towards opposite shoulder causing pain located at ACJ = ACJ pathology