Most of the exam can be done without actually having to touch the patient, just ask them to copy your movements. Musculoskeletal shoulder physical exam checklist written by dr. It is not a diagnostic examination, but basically a screening technique to asses if there may be underlying pathology that needs further investigation. For warmth of shoulder, swelling, tenderness palpate from the sternoclavicular joint clavicle choroid process acromioclavicular joint glenohumeral joint deltoid muscle spine of scapula muscle bulk above and beneath the spine of scapula supra and infra spinatus. A shoulder examination or shoulder exam is a portion of a physical examination used to identify potential pathology involving the shoulder. Aug 14, 2017 a very good step wise approach to basic clinicalorthopedic examination of shoulder for tuku mbbs students of nepal.
Dr stephen snyder and dr tom antkowiak present an update to the scoi 15 point glenohumeral and 8 point bursoscopy exam. The video includes descriptions of normal arthroscopic anatomy as well as examples of anatomic variations. Each example consists of the materials that will be given to the candidate prior to entering the exam room for that skill. Checklist for hand examination undergraduate guide ones in black must do or comment on, ones in blue must comment on only if present or applicable to patient. The glenohumeral joint is located just lateral to the coracoid process acromioclavicular clavicle articulates with the acromion of the scapula.
It is an important cause of anterior shoulder pain and it is usually seen in association with other shoulder pathologies, such as rotator cuff tears and shoulder impingement. This page was last revised on 942019 and last published on 532020. Shoulder exam stanford medicine 25 stanford medicine. Other causes are degenerative joint disease and arthritis. Osces for dentistry features over 150 stations that are often found in undergraduate and postgraduate osces. The affected hip is allowed to drop to the examination table passively. A stepbystep guide to performing shoulder examination in an osce setting, with an included video demonstration. Ask the patient if they have any pain before you start palpating. Arthritis means inflammation of a joint arthron in greek. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. It should be conducted with both shoulders exposed to assess for asymmetry and muscle wasting.
Examination of the shoulder joint introduction introduce yourself wash hands briefly explain to the patient what the examination involves ask the patient to expose their shoulders fully inspection look anterior, lateral, and posterior asymmetry or deformity scars or skin changes muscle bulk palpate temperature. Xray good to check for ghj or acj arthritis can pick up calcific tendinitis, os acromiale, subacromial spur. In the real world it is not uncommon to face patients with rotator cuff injuries and dislocations, or. Abduct shoulder to while the arm is externally rotated with concominant anterior pressure to the humerus. The patient may present with the typical features of inflammation, a hot, red, swollen and painful joint, or just some of these, depending on the cause. Acedillo exam osce items standing inspection anterior level of shoulders and contour joints sternoclavicular, acromioclavicular deltoid wasting swelling, inflammation scars. The patients elbow is flexed to 90 degrees, and the examiner resists the patients active attempts to supinate the arm and. Clinical history taking shoulder orthopaedic surgery e.
Yergason test for biceps tendon instability or tendonitis. The examiner abducts and extends the affected hip before releasing the leg. The posterior force is maintained while the arm is brought into the extreme of external rotation. This video aims to give you an idea of whats required in the osce and you can then. It is useful in identifying pathology that affects the upper limbs. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Feb 22, 20 shoulder examination for orthopedic students. Rotate the shoulder externally by pushing the forearm posteriorly.
Shoulder examination for the mrcs part b ocse surgery. Pain distribution and severity the symptoms may extend toward the scapula, axilla, anterior chest, along the clavicle, or down the humerusa, also important to ask if they. Shoulder exam biceps tendinopathy refers to inflammation or degeneration of the long head of the biceps tendon. This article provides a framework for the initial assessment of a patient presenting with an injured shoulder. You should ensure you are able to perform this confidently. Clinical examinations for doctors, medical student exams, finals, osces and mrcp paces medical examinations and exam questions for medical students, finals, osces, paces and usmle clinical exams cardiovascular examination cardiovascular examination summary with downloadable notes cardiovascular exam detailed osce and paces questions about the cardiovascular examination 30 extended. Please see the terms and conditions this page was written by scott moses, md. Hand and wrist examination musculoskeletal osce skills. A very good step wise approach to basic clinicalorthopedic examination of shoulder for tuku mbbs students of nepal. The ability to test these in a systematic and slick manner is one of the key. By following the structure of this examination technique, we hope you become more comfortable performing a fluid and efficient ocse style shoulder exam. Scoi 15point arthroscopic shoulder exam and 8point. Shoulder examination osce guide old version youtube.
Shoulder examination musculoskeletal osce skills medistudents. Bobby masocol md primary care sports medicine fellow steadman. One of the examiners hands stabilizes the shoulder girdle scapula and clavicle while the other grasps the proximal. Pain suggests ac pathology apprehension test o have the patient in the supine position, with the arm abducted 90 degrees and elbow flexed. Shoulder pain leads many patients to see a primary care physician.
The large number of shoulder examination techniques, often named. A shoulder examination should be performed in a systematic manner. The necessary skills can be developed by examining colleagues or patients. Thieme ebooks, the complex structure of the shoulder, with its variable pathological conditions of rotator cuff disease, degenerative joint disease, and type ii slap lesions, makes clinical examination and assessment difficult for both new and experienced practitioners. Aug 24, 2015 the ability to carry out a thorough and slick shoulder examination is something every medic needs to master. Apr 03, 2016 by following the structure of this examination technique, we hope you become more comfortable performing a fluid and efficient ocse style shoulder exam. For each question, please give the answer that comes closest to the way you have been feeling. Shoulder injuries are common in the primary care setting, yet general practitioners may feel unequipped to confidently assess the patient presenting with shoulder pain. Osce 11 presents a clinical encounter with a 52yearold housepainter with complaints of shoulder pain. Shoulder physical examination starts with inspection.
In each case it is important to be familiar with some basic examination tools that can help us confirm the presence of a shoulder lesion. Common causes include osteoarthritis, rheumatoid arthritis, gout and pseudogout, septic arthritis, the. Prom physical exam muscle testing rotator cuff supraspinatus resistance with ab 90, ff 30, pronated. Briefly explain to the patient what the examination involves. The patient should be properly disrobed to permit complete inspection of both shoulders. Start at the sternum, and move laterally along the clavicle, until you reach the acromioclavicular joint. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Bobby masocol md primary care sports medicine fellow. The shoulder examination, along with all other joint examinations, is commonly tested on in osces. Youll be expected to pick up the relevant clinical signs using your examination skills. Drawer test the patient is seated with the forearm resting on the lap and the shoulder relaxed. Clinical examinations for doctors, medical student exams, finals, osces and mrcp paces medical examinations and exam questions for medical students, finals, osces, paces and usmle clinical exams cardiovascular examination cardiovascular examination summary with downloadable notes cardiovascular exam detailed osce and paces questions about the cardiovascular examination 30.
An extension to this station may be to assess the rotator cuff muscles individually, you should therefore be aware how to do this. The physical examination includes observing the way the patient moves and carries the shoulder. Designed to test clinical reasoning skills, this video provides opportunities to answer questions, practice history taking, and develop an assessment and differential diagnosis as well as an appropriate next diagnostic workup. During the examination, start with observing for discoloration, swelling, abrasions, scars, or any other abnormalities. Physical exam inspection symmetry, atrophy palpation locationdegree tenderness bicepsbicipital groove supraspinatusinsertion ac joint physical exam rom ff, er, ir note discrepancies in arom vs. Content in blue should be in back of your mind so say when you are practicing but not during exam unless seen on the patient in the exam. The likely diagnosis will have been derived from the history. May 11, 2019 ask the patient if they have any pain before you start palpating. Osce example scenarios this document provides example scenarios for skills described in the applied examination objective structured clinical examination osce content outline. A sense of instability with this maneuver suggests anterior. Shoulder examination introduction shoulder disorders are can be broadly classified into the following types.
The book aims to provide frameworks around which many answers and tasks can be performed, so practising with this book will help you to prepare for any station that features in your exam. The patients arm is abducted 90 while the examiner places a posteriorly directed force on the patients humeral head with his hand. The etiology is most of the time traumatic and related either to sport or accidents. Uss good to pick up rotator cuff pathology, calcific tendon, bursitis, dynamic impingement. Compared to other joint exams, the shoulder examination is often chosen as an osce station and you should prepare for it accordingly. This shoulder examination osce guide provides a clear step by step approach to examining the shoulder, with an included video demonstration.
Listen carefully to the patients past medical history pmhx, this may well rule out red flags and guide the shoulder examination. The examination of all joints follows the general pattern of look, feel, move as well as. The result is considered positive if the patient experiences a. Activity left arm right arm florida orthopaedic institute. Instability the common disorders arise from diseases of the following structures. Skillful examination of the shoulder is an integral part of this evaluation and is necessary to generate an appropriate differential diagnosis and to help determine whether advanced imaging is needed.
Case study 48 year sports female administrator and mother of three children she sustains a right ankle inversion injury resulting in a small crack fracture of the tip of her lateral malleolus 6 months prior. Updated 26 may 2018 length 16 min ute s hand and wrist examination. Feb 08, 2020 the exam is a quick way of screening for musculoskeletal dysfunction. It is a disorder that can is present in a whole multitude of diseases. Shoulder pain is one of the most common complaints in the outpatient setting. Dec 18, 2015 shoulder examination is a practical skill which requires background knowledge of anatomy, of normal shoulder function and of abnormalities affecting the shoulder. Check out the shoulder examination mark scheme here. The joint is susceptible to injury due to its high mobility and instability. Observe the patients behavior, comfort level, and functional impairments, if signs of malingering are present. The ability to carry out a thorough and slick shoulder examination is something every medic needs to master.
The shoulder examination follows the look, feel, move rule of joint exams. Examination of the shoulder joints glenohumeral the head of the humerus articulates with the glenoid fossa which is deepened by a ring of fibrocartilage known as the glenoid labrum. The exam is a quick way of screening for musculoskeletal dysfunction. The evaluation of patients with shoulder dysfunction or pain can be difficult. These questions are about how you feel and how things have been with you during the past 4 weeks. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Inspects front for shoulderhip alignment, limblimb discrepancy, shoulder. A collection of musculoskeletal msk osce guides including video demonstrations and osce mark schemes. The upper limb neurological examination is part of the neurological exam that focuses on the motor and sensory neurons that innervate the upper limbs. Validity evidence for two objective structured clinical examination. As you palpate, look at the patients face to see if you elicit any pain. A solid understanding of the anatomy and unique features of the. Positive if patient shows fear of instability shoulder stabilisation problems i.
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