Shoulder Examination

MRCS Part B OSCE Revision


Shoulder Examination

Stacks Image 58501


Wash your hands
Introduce yourself to the patient
Explain that you would like to examine their shoulder joint
Check whether they are in any pain and which the ‘bad’ shoulder is
Stacks Image 57499
Wash Your Hands
Stacks Image 57500
Introduce Yourself


From front, back and side
  • Skin: Scars, bruising/skin changes, swelling
  • Muscle: Asymmetry, deformity (winging of the scapula, wasting of deltoid)
  • Bone & Joint: Position of both shoulders (dislocations)
Remember to check the axillae.
Stacks Image 57537
Inspect From the Front
Stacks Image 57576
Inspect From the Back
Stacks Image 57584
Inspect From the Side


Temperature changes, tenderness or crepitus.
  • Standing in front of the patient: Palpate sternoclavicular joint, clavicle, acromioclavicular joint, acromial process, head of humerus, coracoid process, spine of scapula.
  • Standing Behind the patient: Check interscapula area for pain, feel for rotator cuff defects
  • Palpate supraclavicular area for LNs.
Stacks Image 57616
Palpate The SCJ an Clavicle
Stacks Image 57617
Palpate the ACJ and Glenohumeral Joint


Active (Patient moves) then Passive (Doctor moves) movements. Fell for crepitus during passive movements.

  • Flexion (0-180°): Raise your arms forwards, up over your head.
  • Extension (0-60°): straighten yours arms behind you as far as possible.
  • Abduction (0-180°): Move your arms away from the side of your body until your hands are touching.
  • Adduction (0-45°): : Cross your arms over the front of your body.
  • External Rotation (0-90°): With your arms bent and elbows tucked into your sides move your hands outwards.
  • Internal Rotation (0-90°): Bring your hands together again from the position above.
  • Internal Rotation in adduction: Reach up behind your back and touch your opposite scapula.
  • External Rotation in abduction: Put your hands behind your head.
Stacks Image 57648
Active Flexion
Stacks Image 57649
Active Ab/adduction
Stacks Image 57650
Active Internal Rotation and Extension
Stacks Image 57651
Active Internal/External Rotation
Stacks Image 57652
Active Internal/External Rotation
Stacks Image 57653
Passive Flexion
Stacks Image 57654
Passive Internal/External Rotation
Stacks Image 57662
Passive External Rotation/Extension

Special Tests

Serratus Anterior Function
  • Scapula Winging: Ask patient to put hands with arms outstretched against a wall and push against it. Observe the scapulae from behind. (Winging occurs due to weakness of serratus anterior as a result of damage to long thoracic nerve, brachial plexus injury or viral infections of C5-7 nerve roots.)

Subacromial Impingement Tests
  • Hawkin’s Impingement Test: place the shoulder out at 90 degrees with the arm hanging down, press back on the arm, internal rotation will cause pain with impingement of the supraspinatus tendon against the coraco-acromial ligament.
  • Copeland/Jobe’s Test: The arm is held out to the side and patient internally rotates the shoulder as if pouring out a drink. Passive abduction in internal rotation is painful. Pain is eliminated with passive abduction in external rotation. This suggests the greater tuberosity is being driven up against the acromion.
Glenohumeral Stability Tests
  • Apprehension Test: With the patient seated or supine, externally rotate the shoulder. The patient demonstrates apprehension that the shoulder will dislocate, and will often resist the activity.
Acromioclavicular Joint
  • The Scarf Test: The scarf test is performed with the elbow flexed to 90 degrees, placing the patient's hand on their opposite shoulder and pushing back. Pain or discomfort is indicative of ACJ pathology.
Stacks Image 57680
Impingement Test
Stacks Image 57681
Impingement Test
Stacks Image 57682
Apprehension Test
Stacks Image 57683
Scarf Test
Stacks Image 57684
Scapula Winging Test


Thank the patient
Wash your hands

State that you would like to:
  • Examine the joint above and below (cervical spine and elbow)
  • Get AP and scapula-Y radiographs of the shoulder
  • Assess the patient’s general fitness for surgery
Present your findings to the examiner


Medical imagery licensed under Creative Commons Attribution-Share Alike license; sourced from Wikipedia
All other textual content, imagery, and website design copyright © 2014-22 MRCS Part B Questions all rights reserved.
Contact Us | Privacy Policy | Terms and Conditions