1/9/2020 Shoulder Exam - OSCE Stations

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Shoulder Exam

Introduces self 0 1

Con rms name & age of patient 0 1

Explains & gains consent 0 1

Asks if patient su ers from pain, sti ness or reduced range of movement in the shoulder 0 1

Washes hands 0 1

Exposes patient’s shoulders and the joints more proximal and distal (back, elbow and hand) and 0 1
asks them to stand

General inspection around bed and patient (walking aids, obvious scars, wasting or deformities) 0 1

Inspects front for shoulder/hip alignment, limb-limb discrepancy, shoulder architecture 0 1

Inspects back for wasting of muscles (trapezius, paraspinal, deltoids), scoliosis, skin changes, 0 1
scars, winging of scapulae

Inspects sides for xed exion deformities, increased kyphosis or lordosis, carrying angle of the 0 1
elbow

Palpates for temperature 0 1

Palpates the shoulder joints for tenderness/e usions from the sternoclavicular joint, along the 0 1 2
clavicle, acromioclavicular joint and acromion. Also feel the joint line, the tuberosities and the
glenohumeral joint and scapulae
Palpates the biceps tendon for tendonitis 0 1

Assesses function by asking patient to place their hands behind their head and behind their 0 1 2
back as far up as they can go

Assesses active abduction (normal: 180 degrees) observing for a painful arc. Repeat passively 0 1 2
observing movement of scapula and feeling for crepitus

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1/9/2020 Shoulder Exam - OSCE Stations
Assesses active adduction (50 degrees) by moving arms towards the midline and across the 0 1
chest. Extend passively if required.
Assesses active exion (165 degrees) and extension (65 degrees). Extend passively if required. 0 1 2

Assesses external rotation (60 degrees) by asking patient to tuck their elbows in and rotate out. 0 1
Extend passively if required. Marked loss in adhesive capsulitis or ‘frozen shoulder’

Assesses supraspinatus by asking patient to extend their arms and abduct 90 degrees, 0 1
internally rotate slightly with thumbs pointing down. Test their strength by asking patient to
resist you pushing down.

Assesses infraspinatus and teres minor by asking patient to ex their elbow by 90 degrees and 0 1
abduct their shoulder 30 degrees. Test their strength by asking patient to externally rotate
against your hands

Assesses subscapularis by asking patient to place their hands behind their back palmar surfaces 0 1
outwards. Ask them to push away from their body whilst you resist to test their strength

O ers the apprehension test for anterior dislocation. Have patient standing with elbows 90 0 1 2
degrees exed. Abduct and externally rotate the shoulder with one hand whilst applying
pressure over the head of the humerus in an anterior direction
O ers Hawkin's test/Neer’s test and Scarf test 0 1

O ers examination of back and elbow exam, neurovascular exam and history 0 1
Thanks patient and o ers help to redress 0 1
Washes hands 0 1
O ers next step (imaging: 2 plain x rays for bony pathology or CT if indicated, MRI for soft 0 1
tissue)
Summarises appropriately with only key ndings 0 1
O ers appropriate di erential diagnoses 0 1

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