From Front



- scars




- clavicle


- biceps (rupture long head)


Popeye Biceps



- deltoid

- trapezius

- arm


Deltoid Wasting


From Side


Turn affected side towards you


- pectoral contour


From Back


Scapular symmetry

- height

- winging 



- supraspinatus

- infraspinatus


SS IS Clinical Photo 1SS IS Clinical Photo 2



"Where is it painful ?"


Bony prominences


- clavicle

- ACJ (compare with other side)

- acromium

- biceps tendon


Scapular spine


Supraspinous fossa

- ganglion

- osteochondroma


Infraspinous fossa

- tenderness

- cuff defect




Forward flexion



- both arms raised forward, supinated

- range

- check axilla





- elevate both arms in coronal plane, supinated

- initiation

- range (160°-180°)

- rhythm

- arc of pain

- shoulder hiking



- if not full, passive to 180?

- active v passive


Observe arm lowering 

- arc of pain

- drop arm





- both arms raised backward


External rotation




Elbows flexed to 90o and arms by side

- start with arms forward

- rotate arms outwards (90°)



If not full, passive


Reduced ER


Internal rotation



- ask to run thumb up spine

- mark good and compare bad

- thigh / buttocks / waist / LS / T12 / angle of scapula (T7) / tip of scapula (T2)


Rotator Cuff Power / Integrity


Power of supraspinatous

- 30° abduction

- in plane of scapula (30° forward from coronal plane)

- forearm pronated (thumb to the ground)

- resisted abduction


Supraspinatous testing


Power of Infraspinatous


1. Grade power external rotation


Infraspinatous Power


2.  Extensor lag

- take out to full passive ER

- release and see if lags


3.  Hornblower's

- positive if drop and IR

- suggests massive PS tear

- teres minor


Power of Subscapularis


1.  Gerber's Lift off test

- Gerber's test is normal if patient can hold hand off buttock

- patient must have full IR & not be limited by pain to use this test

- "Pathological lift off test - patient is unable to lift the dorsum of his hand off his back"

- put dorsum of patient's hand on buttock then lift it off buttock & let go


Subscapularis Lift Off Test 1Subscapularis Lift Off Test 2


2. Belly Press Test / Nelaton Test

- resisted internal rotation with hand on belly

- must keep elbow forward

- otherwise patient uses shoulder retractors

- positive if drop elbow


Subscapularis Belly Press Test


Impingement tests


Neer's impingement test

- passive forward flexion 

- forearm pronated

- scapula stabilised

- positive test - pain at arc 70-120°


Shoulder Neers Test


Hawkin's impingement test

- forward flex elbow to 90°

- internally rotate and adduct arm

- positive test - pain


Shoulders Impingement Test




Cross body adduction


ACj Cross Body Adduction Test




Speed's test

- resisted forward flexion at 90° with forearm supinated

- assess pain or popping at bicipital groove (long head of biceps)


Speeds Test


Yergason's Test

- externally rotate arm with elbow 90°

- resisted supination

- assess pain or popping at bicipital groove (long head of biceps)


Yergason's Test


Compression-Rotation test / McMurray's Shoulder test

- test for SLAP lesion

- patient supine 

- shoulder abducted 90°, elbow flexed 90°

- compression force to humerus

- humerus rotated

- attempt to trap torn labrum, positive if pain & click



- SLAP lesion

- arm across body, in plane of scapula

- pain with stress abduction, thumb down

- nil pain with thumb up


Obriens Test




Sulcus sign

- needs to be compared to the opposite side

- patient

- in front of patient

- hands in lap

- pull down on both elbows

- look for sulcus


Shoulder Sulcus Sign


Anterior / Posterior Drawer

- sit next to patient

- stabilise shoulder girdle with 1 hand

- thumb on spine of scapula

- forefinger on coracoid

- centralize humerus

- must compare to normal side

- translate humeral head forward with other hand

- anterior & posterior translation noted


Anterior Apprehension Test

- patient lying

- shoulder abducted and elbow flexed 90°

- externally rotate shoulder

- positive test - look for apprehension 


Jobe Relocation Test

- patient supine

- arm abducted to 90°

- forced external rotation

- relocate by pushing humeral head posteriorly & superiorly

- usually described by putting hand on humeral shaft


Posterior Stress Test 

- stabilise scapula

- place shoulder in 90° forward flexion & 90° IR & adducted

- apply posterior force

- patient experiences pain +/- apprehension

- unlike anterior test patient has positive test if pain only

- note should reproduce the patients symptoms


Load and Shift

- patient lying down

- their hand under examiners armpit

- grasp neck of humerus with both hands

- load humerus into glenoid axially

- examinate stability annterior and posterior


Ligamentous Laxity


Wynne-Davies Criteria

1. Thumb touching forearm on flexing wrist

2. Fingers parallel to forearm with wrist extension

3. Elbows extend past 180°

4. Knees extend past 180°

5. Foot dorsiflex past 45°


Ligamentous Laxity Elbow HyperextensionLigamentous Laxity Thumb to Forearm


"If 3 of the 5 pairs of joints examined in any one individual showed this degree of laxity it is taken as positive."


Thoracic Outlet Tests


Adson Manoeuvre

- head toward side tested, neck extended

- palpate radial pulse of extended arm

- patient inhales deeply

- positive test if decrease or obliteration in pulse with concomitant reproduction of symptoms


Wright's Manoeuvre

- head turned away from tested arm, neck extended

- arm in 90° abduction & 90° extension

- palpate radial pulse 

- patient inhales deeply

- positive test if decrease or obliteration in pulse with concomitant reproduction of symptoms




Cephalad Joint Neck




Compression Test

- slight extension

- compression


Spurling's test

- neck in lateral flexion, rotation

- stressed with compression

- positive if pain in ipsilateral extremity




Radial pulse