Examinations
CPSA · Clinical examination · Musculoskeletal
Shoulder examination
Look → feel → move (active/passive) → special tests for the rotator cuff and impingement.
Practise it out loudPosition: Patient standing/sitting, both shoulders fully exposed.
The routine
Look
- 1Front, side and behind: wasting (deltoid, supra/infraspinatus), asymmetry, scars, winging of the scapula
Feel
- 1Temperature; palpate the sternoclavicular joint, clavicle, AC joint, acromion, greater tuberosity, spine of scapula
Move
- 1Active then passive: flexion, extension, abduction, adduction, internal/external rotation; note a painful arc (60–120° = impingement)
Special tests
- 1Supraspinatus (empty-can/Jobe), infraspinatus (resisted ER), subscapularis (Gerber lift-off)
- 2Impingement (Hawkins-Kennedy, Neer)
Signs & what they mean
Painful arc 60–120°, positive Hawkins-KennedySubacromial impingement
Weakness on empty-can test, inability to initiate abductionSupraspinatus (rotator cuff) tear
Global restriction of active AND passive movementAdhesive capsulitis (frozen shoulder)
Loss of external rotation + OA changesGlenohumeral osteoarthritis
To complete, I would…
- Examine the neck (cervical spine) and the elbow
- Assess neurovascular status (axillary nerve)
- Request X-ray ± ultrasound/MRI of the cuff
OSCE tips
- A painful arc 60–120° suggests subacromial impingement.
- Restricted passive movement points to a frozen shoulder (not just a cuff tear).
- Always examine the neck — cervical pathology refers to the shoulder.