Palpation of the Shoulder Region – Part 2 – Clinical Examination

Palpation of the Shoulder Region – Part 2 – Clinical Examination


Palpation of the Shoulder Region Following inspection, shoulder examination continues by first palpating
for any inflammatory signs, such as warmth, swelling, or tenderness. Afterwards, a more detailed palpation of the muscle and bone structures within the shoulder
region should be conducted from the front and rear of the patient. Start by
palpating the surface of the sternoclavicular joint and pay attention
to any tenderness or swelling which may indicate osteoarthritis or subluxation.
If the joint is tender, testing its mobility should be restricted according
to pain. If the joint is non-tender, mobility may be tested as normal. Motion
is tested by grasping the clavicle with one hand and gently pressing it up and
down. Pay attention to any pain which can be a sign of trauma or osteoarthritis.
Abnormally increased mobility may also be a sign of trauma or a connective
tissue disorder. Continue palpation along the clavicle to
its lateral end where the acromioclavicular joint is located. Watch
out for any signs of a fracture, such as pain, swelling, or displacement. A lateral
clavicle that is cranially dislocated and can be repositioned with minimal
pressure is known as the piano key sign, which indicates injury to the AC joint.
From here, palpate the coracoid process of the scapula, in the infraclavicular
fossa. The process can be located as it moves
with the scapula, while the arm is flexed forward. Pain in this area can indicate an
insertion tendinopathy of the short head of the biceps, of the pectoralis
minor muscle, or the coracobrachialis muscle. Proceeding from this point, palpate the
greater tubercle. Tenderness in this area may indicate
pathology of the rotator cuff muscles inserted here, which include: the
supraspinatus, the infraspinatus, and the teres minor.
The greater tubercle can be felt by slowly rotating the upper arm
in and out. Lastly, important points on the scapula
should be palpated from the rear. These include: the scapular spine, it’s medial border, it’s inferior angle, and it’s lateral border.
Muscular atrophy and noticeable shoulder malposition can suggest nerve damage or
acute brachial neuropathy, otherwise known as Parsonage Turner Syndrome.

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