II. Exam: Inspection (from all angles and with Shoulder fully exposed)

  1. Swelling and Bruising in recent Trauma
  2. Scars suggesting old Trauma
  3. Deformity
    1. Acromioclavicular joint
    2. Clavicle
    3. Glenohumeral joint (in acute dislocations)
  4. Asymmetry
    1. Disuse atrophy of the supraspinatus muscle
      1. Chronic Rotator Cuff Tear or Shoulder Impingement
      2. Efficacy of atrophy as test for Rotator Cuff Syndrome
        1. Test Sensitivity: 56%
        2. Test Specificity: 73%
    2. Shoulder sag
      1. Cranial Nerve 11 disorder
    3. Sulcus at glenohumeral joint
      1. Seen with acute Shoulder Dislocation

III. Exam: Palpation

  1. Grading of pain
    1. No pain: 0
    2. Mild pain: 1
    3. Moderate: 2
    4. Severe: 3
  2. Technique
    1. Both Shoulders exposed
    2. Palpate for atrophy or swelling
    3. Assess contour of Shoulder
    4. Palpate for tenderness in both Shoulders
      1. Acromioclavicular (AC) joint
        1. Acromioclavicular Joint Osteoarthritis or
        2. AC Seperation
      2. Biceps Tendon tenderness
        1. Bicipital Tendonitis
      3. Greater tuberosity of Humerus (and supraspinatus)
    5. Palpate fibromyalgia Tender Points at occiput and medial trapezius muscle
      1. Assess for comorbid myofascial pain

IV. Exam: Specific Shoulder Tests (see categories below for full descriptions)

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