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Joint Complex
Mike Reinold, DPT, SCS, CSCS
MikeReinold.com
Champion PT and Performance
Boston, MA
I. Introduction
A. Clinical Examination
1. Subjective history
2. Inspection / observation
3. Clearing the cervical spine
3. Active range of motion
4. Passive range of motion
5. Manual muscle testing
6. Accessory motion assessment
7. Laxity testing
8. Special tests
9. Palpation
10. Neurovascular assessment
11. Functional assessments
12. Imaging studies / radiographs
Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 2
6. Chief complaint
III. Observation
A. Symmetry
B. Posture
1. Head position
2. Shoulder position
3. Pectoralis position
3. Scapular position
4. Spine position
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 3
V. Range of motion
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 4
a. Painful arc
b. Quality of motion
c. Quantity of motion
4. Scapulohumeral rhythm
Motion 10-20 years 20-40 years 40-54 years 60-85 years 61-93 years
Boone JBJS 79 Boone JBJS 79 Boone JBJS 79 Walker Phys Ther 84 Downey Phys Ther 91
FLX 167.4 165 165.1 160 165
EXT 64 58 56.1 38 -
IR 70.3 66.5 68.3 59 65
ER 106.3 101 97.5 76 80.6
ABD 185.1 182.7 182.6 155 157.9
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 5
Motion Baseball Players PROM Baseball Players AROM Tennis Players AROM
Wilk AJSM 02 Ellenbecker MSSE 02 Ellenbecker MSSE 02
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
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3. Lag Signs
Hertel: JSES 96
Supraspinatus Infraspintus/Supraspinatus
Gerber: JBJS 91
C. Impingement
1. Impingement sign
Neer: Orthop Clin NA 77
2. Hawkins test
Hawkins: AJSM 80
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 8
D. Biceps provocation
1. Inferior glide
2. Posterior glide
3. Anterior glide
4. Lateral glide
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 9
B. Seated position
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 10
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 11
5. Relocation test
Jobe Orthop Rev 89
6. Apprehension test
3. Posterior fulcrum
Norwood: AJSM 84
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 12
4. Push-pull test
Matsen: 90
A. Speeds tests
B. Grind test
Compression-Rotation
Snyder: Arthroscopy 90
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
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E. Anterior slide
Kibler: Arthroscopy 95
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 14
A. Spring sign
B. Shear test
Davies: Phys Sports Med 81
C. Horizontal adduction
D. OBriens test
OBrien: AJSM 98
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 15
X. Neurovascular
A. Neurological function
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
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C. Thoracic outlet
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 17
XI. Palpation
A. Specific structures
1. Greater tuberosity rotator cuff insertion
2. Biceps brachii (proximal)
3. Coracoid process
4. Subacromial bursa
5. Anterior deltoid
6. Infraspinatus internal impingement location
7. Quadralateral space
8. 1st rib
9. Acromioclavicular joint
10. Scapular mobility (crepitus, etc) during AROM
XII. Functional Assessment
A. Specific shoulder assessment forms
1. American Shoulder Elbow Surgeon Form
2. UCLA Shoulder Form
3. Jobe-Tobonie Athletic Shoulder Form
4. Modified Athletic Shoulder Form Reinold, Wilk, Andrews
5. Mimori Scoring System
XIII. Summary
A. Key Points
1. Systemic approach to shoulder exam
2. Logical progression
3. Knowledge of anatomy & biomechanics
4. Establish chief complaints
5. Correlate clinical findings to history
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
Page 18
References
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Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
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MikeReinold.com | ShoulderSeminar.com
Clinical Examination of the Shoulder
Mike Reinold, DPT, SCS, CSCS
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