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and Teres Minor –
Posterior View

RC Testing - Subscapularis
Anatomy: Connects scapula to

humerus, w/origin on anterior
surface of scapula.
FiringÆinternal rotation.

Function can be tested using
"Gerber's lift off test:"

1. Patient places hand behind
back, palm facing out.

2. Pt lifts hand away from back.
3. If tendon partially torn,

movement limited or causes
pain. Complete tears
prevents any movement in
this direction

Sucscapularis – Anterior View

Impingement, Rotator Cuff Tendonitis and
Sub-Acromial Bursitis

• 4 tendons of RC pass
underneath acromion/coraco-
acromion ligamentÆ insertions

on humerus.
• Space between

acromion/coracoacromial lig &
tendons can become narrowed

• Causes tendons (in particular,
supraspinatus) to become
"impinged upon.Ӯresulting
friction inflames tendons &
subacromial bursa (between
tendons & acromion).

• Net result =s shoulder pain,
particularly raising arm over
head (e.g. swimming, reaching
up on a top shelf, arm
positioning during sleep).
Anatomy - Impingement
and Bursitis

Neer’s Test For Impingement
1. Place 1 hand on

patient's scapula, &
grasp forearm
w/other. Arm
internally rotated
(thumb pointed

2. Foreward flex arm,
positioning hand
over the head.

3. PainÆ
impingement. Shoulder Anatomy Fig 5 - AAFP

Evaluation Painful Shoulder

Hawkin’s Test For Impingement
and Subacromial Palpation

Hawkin’s Test:
1. Raise patient's arm to 90

degrees forward flexion.
2. Rotate internally (i.e. thumb

pointed down)Æplaces greater
tubercle humerus in position to
further compromise space
beneath acromion.

3. PainÆ impingement.

Subacromial Palpation:
1. Identify acromion by following

scapular spine laterally to tip
2. Palpate in region sub-acromial

spaceÆ pain if tendons/bursa

Subacromial Palpation

Shoulder Anatomy Fig 5 -
AAFP Evaluation Painful

Biceps Tendon – Anatomy and Function

• Long head biceps tendon
runs in bicipital groove
humerus, inserting @ top
of glenoid.

• Subject to same
forces/stresses as
tendons of RC.

• Biceps flexes &
supinates forearm; also
helps flex.

• Inflammation
(tendonitis)Æpain @ top
& anterior shoulder
areas, particularly
w/flexion or supination.
Anatomy – Biceps Tendon

Biceps Tendon Testing and

1. Palpate biceps tendon bicipital

groove. PainÆtendonitis.
2. Confirm you’re on tendonÆ

patient supinates while you

Resisted Supination (Yergason’s

1. Elbow flexed 90 degrees,
shoulder adducted (ie elbow
bent @ right angle, arm against

2. Grasp patient's hand, direct
them to rotate arm such that
hand is palm up (supinate)
while you resist.

3. PainÆtendonitis

Palpation Yergason’s

“Popeye Muscle”ÆBicep’s Rupture

Popeye The Sailor

Acromio-Clavicular Joint Pathology

• A-C joint minimally mobile.
Inflammation &
degenerationÆ shoulder

Specifics of Testing:
1. Palpate point @ which end

of clavicle articulates

2. Push on areaÆ ? pain
3. Ask patient to move arm

across chestÆstresses A-C
jointÆ pain in setting of

4. A-C joint separationÆ
swelling & pain on cross arm
testing or palpation

Palpation of A-C Joint

A-C Joint Testing - Fig 7 - AAFP
Evaluation Painful Shoulder
Anatomy – A-C Joint Pathology

□ Observation, palpation General orientation

□ Range of motion (flexion/extension, abduction/adduction,
internal/external rotation), with palpation

Decreased with variety shoulder pathology, crepitus on
palpation with DJD

□“Empty can test” (arm abducted 60 degrees, forward
flexed ~ 30 degrees, thumb down, resistance to additional

Pain/weakness suggests Supraspinatus tear

□ Resisted external rotation Pain/weakness suggests Infraspinatus or Teres Minor tear

□ Resisted internal rotation and lift off from back (Gerber’s

Pain/weakness suggests Subscapularis tear

□ Sub-acromial palpation Pain suggests bursitis/impingement

□ Hawkin’s test (elbow 90 degrees, arm forward flexed 90
degrees, examiner internally rotates)

Pain suggests bursitis/impingement

□ Neer’s test (thumb down, elbow straight, examiner raises
arm thru forward flexion)

Pain suggests bursitis/impingement

□ Long head biceps palpation Pain suggests biceps tendonitis

□Yergason’s (elbow 90 degrees, arm adducted, patient
attempts supination while examiner resists)

Pain suggests biceps tendonitis

□A-C joint tenderness, Cross arm test (reach across
towards opposite shoulder)

Pain suggests a-c joint pathology (djd, dislocation)

Maneuver Clinical Interpretation
Summary of Maneuvers – Shoulder Exam

	Musculoskeletal Examination: General Principles and Detailed Evaluation Of the Knee & Shoulder
	General Principles
	Historical Clues
	Examination Keys To Evaluating Any Joint
	Terminology: Flexion/Extension, Abduction/Adduction
	Knee Anatomy:�Observation & Identification of Landmarks
	Observation (cont)
	Range of Motion (ROM)
	Assessment For A Large Effusion - Ballotment
	Menisci – Normal Function and Anatomy
	Evaluating for Meniscal Injury – Joint Line Palpation
	Additional Tests For Meniscal Injury McMurray’s Test – Medial Meniscus
	McMurray’s Test – Lateral Meniscus
	Additional Assessment For Meniscal Injury – Appley Grind Test
	Ligaments – Normal Anatomy and Function
	Specifics of Testing – Medial Collateral Ligament (MCL)
	Lateral Collateral Ligament (LCL)
	Another Method For Assessing The LCL and MCL
	Anterior Cruciate Ligament (ACL) – Lachman’s Test
	Drop Lachman’s Test�For Patient’s With Big Legs &/or Examiners With Small Hands
	Posterior Cruciate Ligament (PCL) – Posterior Drawer Test
	Anterior Knee Pain: Assessment for Patellofemoral Problems and Chondromalacia
	Slide Number 23
	The Shoulder Exam�Overview of Anatomy
	Anatomy – Anterior View
	Observation & Palpation
	Active Range Of Motion�Flexion/Extention and Abduction/Adduction
	ROM Cont – Internal/External Rotation
	Passive ROM
	The Rotator Cuff
	RC Testing – Supraspinatus�(“empty can test”
	RC Testing – Infraspinatus and Teres Minor
	RC Testing - Subscapularis
	Impingement, Rotator Cuff Tendonitis and Sub-Acromial Bursitis
	Neer’s Test For Impingement
	Hawkin’s Test For Impingement and Subacromial Palpation
	Biceps Tendon – Anatomy and Function
	Biceps Tendon Testing and Pathology
	Acromio-Clavicular Joint Pathology
	Slide Number 40