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Examination of the shoulder joint

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The shoulder joint could be described as a trade-off between range and stability. The striking range of movement of this joint is achieved by its shallow articulation and a dynamic cuff of the shoulder muscles and their associated tendons. It is therefore not surprising that ageing has more impact on the soft tissues of the shoulder than on other more stable and less dynamic joints.

An Australian population study1 showed the importance of the history and examination of the shoulder, rather than imaging. In this study, multiple asymptomatic changes in the magnetic resonance imaging (MRI) scan were observed in healthy individuals, and there was a poor correlation between shoulder pain and change in the MRI scan. In many cases, the clinical examination features are mainly diagnostic. Worldwide, there is a well defined, age-dependent increase in the frequency of rotator cuff tears in asymptomatic shoulders.2 In keeping with many joint examination techniques, a series of steps (including look, feel, move and special tests) remains valid with the shoulder.

Physical examination is not a blind or formulaic activity. We need to examine the patient in a sequence to answer specific questions based on diagnoses that may become more or less likely as the examination proceeds (Box 1). The first question should be: is the pain really emanating from the…