Makindo Medical Notes.com

Introduction (Use the acronym WIPER to prepare for the examination)

• W - Wash your hands
• I - Introduce yourself and confirm patient details
• P - Permission - gain consent to proceed with the examination, including explaining relevant details
• E - Expose the patient appropriately, gather Equipment
• R - Position the patient lying back at 45 degrees comfortably

• Inspect
  • Slings, casts, splints, Walking aids, Zimmer frames
  • Inspect patient standing
    • Muscle wasting, Deformities
    • Scars - arthroscopy portals, surgical scars
    • Sinuses, Swelling, Erythema
    • Position of the shoulders - Bryant's sign (Lowering of the axillary fold demonstrates dislocation)
    • Bony deformity (fractures, winging of the scapula)
  • Screen main muscle groups
    • Arms raised above head with shoulder fully abducted
    • Hands raised and placed behind back of head
    • Hands placed at lower lumbar back
  • Palpates shoulder joint
    • Temperature
    • Swelling
    • Muscle bulk around joint, scapula
  • Joints: sternoclavicular, acromioclavicular, glenohumeral joints
  • Scapula
• Assesses movements:
  • Flexion (0-180 degrees)
  • Extension (0-50 degrees)
  • Abduction (0-180 degrees)
  • Adduction (0-50 degrees)
  • External rotation (0-90 degrees)
  • Internal rotation (0-70 degrees)
• Assesses passive, active and resisted movements
• Assesses degree of passive and active movement
• Assesses for pain and crepitus
• Stabilises with other hand while assessing movement
• Checks for painful arc (70-120 degrees) upon abduction Assess for winging of scapula - push against wall Special tests:
• Rotator cuff tests:
• Full can test
• Lift-off test
• Infraspinatus and teres minor test
• Impingement tests:
• Neer's impingement test
• Hawkins-Kennedy test
• Instability test:
• Anterior instability test
• Sulcus sign
• Load shift sign
• Yergason's test:
• Biceps - resisted supination with long head of the biceps pathology causes pain in the bicipital groove Thanks patient Offers to help patient get dressed Washes hands Offers to examine elbow (joint below) and neck (joint above) Offers to examine neurovascular function of lower limbs Presents findings Offers appropriate differential diagnosis Suggests appropriate investigations and Management