OSCE Shoulder exam
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🧾 Introduction – Shoulder Examination (OSCE)
- 🧼 W – Wash hands
- 🙂 I – Introduce yourself & confirm patient details
- ✅ P – Permission & consent: explain exam, ask if comfortable
- 👕 E – Expose shoulders appropriately (both sides visible)
- 🛋️ R – Position: seated or at 45° (for inspection); standing for functional tests
👀 Inspection
- Paraphernalia: slings, casts, splints, walking aids
- Look from front, side & behind:
- Muscle wasting (esp. deltoid, supraspinatus, infraspinatus)
- Scars (arthroscopy portals, surgical scars)
- Sinuses, swelling, erythema
- Bony deformities: step deformity, clavicle, winged scapula 🪽
- Asymmetry or abnormal posture → Bryant’s sign (low axillary fold = dislocation)
- Screening functional movements:
- Arms fully abducted overhead 🙆♂️
- Hands behind head 🙇♂️
- Hands behind lower back 🙍♂️
✋ Palpation
- Check temperature & swelling around joint
- Palpate sternoclavicular, acromioclavicular, & glenohumeral joints
- Assess scapula: muscle bulk, tenderness, deformity
🌀 Movements (Always compare both sides)
- Active, then passive, then resisted (with scapula stabilised)
- Flexion: 0–180°
- Extension: 0–50°
- Abduction: 0–180° (painful arc 🌈: 70–120° = supraspinatus impingement)
- Adduction: 0–50°
- External rotation: 0–90°
- Internal rotation: 0–70°
- Assess for pain, limitation, crepitus
🔍 Special Tests
- Rotator cuff:
- Full Can / Jobe’s test – supraspinatus
- Lift-off test – subscapularis
- External rotation against resistance – infraspinatus & teres minor
- Impingement:
- Neer’s test (arm forced overhead)
- Hawkins–Kennedy test (internal rotation at 90° flexion)
- Instability:
- Anterior apprehension test
- Sulcus sign
- Load & shift test
- Biceps tendon:
- Yergason’s test – resisted supination → pain at bicipital groove
- Scapula:
- Winging – ask patient to push against wall
🙏 Completion
- Thank patient & redress
- Wash hands 🧼
- Say you would examine:
- Joint above (neck) & below (elbow)
- Neurovascular exam of the limb
- Present findings systematically
- Suggest differentials (rotator cuff tear, adhesive capsulitis, OA, dislocation, impingement)
- Propose investigations (X-ray, USS/MRI, bloods if systemic)
🌟 OSCE Pearls
- Always compare sides & comment on painful arc
- Stabilise scapula when testing rotation
- Include inspection from behind for muscle wasting & scapula winging
- Verbalise: “I would complete by examining cervical spine and elbow”
- For extra marks: link findings to functional deficit (e.g., supraspinatus tear → difficulty abducting above shoulder level)
