Clinical conditions affecting the shoulder


Shoulder abduction Shoulder depression Shoulder flexion


Clinical examination.

In performing any clinical examination, always remember that inspection comes first, followed by palpation and hen percussion and finally auscultation.


Observations of surface myology is part of inspection. It is important to recognise muscle wasting, and deformities such as in Dupuytren’s contracture. Muscle disability can arise as a result of loss of nerve supply, blood supply or rupture due to trauma. It is important to remember the different types of nerves and their nerve roots in the identification of muscle paralysis.

In testing the power of individual muscles the Medical Research Council (Britain) recommends that the following gradings should be followed


  • 0        active contraction

  • 1        visible contraction without active movement

  • 2        movement which is possible with gravity eliminated

  • 3        movement which is possible against gravity

  • 4        movement which is possible against gravity plus resistance but which is weaker than normal power

When muscle weakness is suspected due to nerve damage, in the process of testing, there is the need to perform a thorough neurological examination which involves the study and examination of the dermatomes supplied by the nerve roots that provide motor supply to the muscles under study.

  • The muscles of the pectoral girdle and the shoulder can be tested by the range of movements affected by the shoulder joint. They are abduction, adduction, external rotation and internal rotation. Abduction and adduction will normally test the action of the pectoral muscle and the deltoid. Rotation will test the action of the rotator cuff muscles.

  • Raised arm test can be used in determining the integrity of the shoulder arc. For example when a patient is asked to raise his two arms up with the palm touching above, if normal he experiences no pain. If abnormal, then action causes pain at the range of 60o-120o and this may be caused by rupture of supraspinatus tendon and the condition is then termed the painful arc syndrome.



Shoulder flexion Shoulder rotation Shrugging

Anterior approach to shoulder 




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