History Taking and Clinical Assessment of the Shoulder

  • Simon RobinsonEmail author
  • Nanette Oakes
  • Shantanu Shahane


A reproducible and accurate assessment of the shoulder is important before contemplating investigations and a treatment plan. In this chapter, we are describing our way of assessing the patient who presents with shoulder related symptoms. This chapter will include important history taking points and examining the shoulder. This is however not an exhaustive chapter on all the possible special tests, which can be used when performing a clinical assessment. We will explain our system and thought processes and provide reasoning for our methods and the tests we have chosen.


Shoulder examination Shoulder assessment 


  1. 1.
    Codman EA. The shoulder: rupture of the supraspinatous tendon and other lesions in and about the subacromial bursa. Chap 5. Boston: Thomas Todd; 1934. p. 123–77.Google Scholar
  2. 2.
    Williams GR, Nguyen VD, Rockwood CA. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989;18:29–34.Google Scholar
  3. 3.
    Barnes CJ, Van Steyn SJ, Fischer RA. The effects of age, sex, and shoulder dominance on range of motion of the shoulder. J Shoulder Elb Surg. 2001;10(3):242–6.CrossRefGoogle Scholar
  4. 4.
    American Academy of Orthopaedic Surgeons. Joint motion: method of measuring and recording. Chicago: American Academy of Orthopaedic Surgeons; 1965.Google Scholar
  5. 5.
    Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg. 1972;54A:41–50.CrossRefGoogle Scholar
  6. 6.
    Neer CS II. Impingement lesions. Clin Orthop. 1983;173:70–7.Google Scholar
  7. 7.
    Hawkins R, Kennedy J. Impingement syndrome in athletes. Am J Sports Med. 1980;8(3):151–8.CrossRefGoogle Scholar
  8. 8.
    McLaughlin HL. On the frozen shoulder. Bull Hosp Joint Dis. 1951;12:383–90.PubMedGoogle Scholar
  9. 9.
    Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med. 1982;10(6):336–9.CrossRefGoogle Scholar
  10. 10.
    Jobe FW, Jobe CM. Painful athletic injuries of the shoulder. Clin Orthop. 1983;173:117–24.Google Scholar
  11. 11.
    Itoi E, Kido T, Sano A, Urayama M, Sato K. Which is more useful, the “full can test” or the “empty can test,” in detecting the torn supraspinatus tendon? Am J Sports Med. 1999;27(1):65–8.CrossRefGoogle Scholar
  12. 12.
    Kelly BT, Kadrmas WR, Speer KP. The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med. 1996;24(5):581–8.CrossRefGoogle Scholar
  13. 13.
    Hertel R, Ballmer FT, Lombert SM, et al. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elb Surg. 1996;5:307–13.CrossRefGoogle Scholar
  14. 14.
    Merolla G, De Santis E, Sperling JW, Campi F, Paladini P, Porcellini G. Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis. J Shoulder Elb Surg. 2010;19(8):1256–64.CrossRefGoogle Scholar
  15. 15.
    Arthuis M. Obstetrical paralysis of the brachial plexus I. diagnosis: clinical study of the initial period. Rev Chir Orthop Reparatrice Appar Mot. 1972;58:124–36.Google Scholar
  16. 16.
    Goutallier D, Postel J-M, Bernageau J, Lavau L, Voisin M-C. Fatty muscle degeneration in cuff ruptures. Clin Orthop. 1994;304:78–83.Google Scholar
  17. 17.
    Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998;80(4):624–8.CrossRefGoogle Scholar
  18. 18.
    Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076–84.CrossRefGoogle Scholar
  19. 19.
    Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389–94.CrossRefGoogle Scholar
  20. 20.
    Greis PE, Kuhn JE, Schultheis J, Hintermeister R, Hawkins R. Validation of the lift-off test and analysis of subscapularis activity during maximal internal rotation. Am J Sports Med. 1996;24(5):589–93.CrossRefGoogle Scholar
  21. 21.
    Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78:1015–23.CrossRefGoogle Scholar
  22. 22.
    O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–3.CrossRefGoogle Scholar
  23. 23.
    Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med. 2004;32(3):655–61.CrossRefGoogle Scholar
  24. 24.
    Guanche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19(5):517–23.CrossRefGoogle Scholar
  25. 25.
    Bennett WF. Specificity of the Speed’s test: Arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;8:789–96.CrossRefGoogle Scholar
  26. 26.
    Holtby R, Razmjou H. Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20(3):231–6.CrossRefGoogle Scholar
  27. 27.
    Yergason RM. Supination sign. J Bone Joint Surg Br. 1931;13:160.Google Scholar
  28. 28.
    Myers JB, Wassinger CA, Lephart SM. Sensorimotor contribution to shoulder stability: Effect of injury and rehabilitation. Man Ther. 2006;11:197–201.CrossRefGoogle Scholar
  29. 29.
    Jaggi A, Lambert S. Rehabilitation for shoulder instability. Br J Sports Med. 2010;44:333–40.CrossRefGoogle Scholar
  30. 30.
    Lewis A, Kitamura T, Bayley JIL. Mini symposium: shoulder instability (ii). The classification of shoulder instability: new light through old windows! Curr Orthop. 2004;18:97–108.CrossRefGoogle Scholar
  31. 31.
    Beighton PH, Horan F. Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg (Br). 1969;51:444–53.CrossRefGoogle Scholar
  32. 32.
    Neer CS II, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: a preliminary report. J Bone Joint Surg Am. 1980;62:897–908.CrossRefGoogle Scholar
  33. 33.
    Gagey OJ, Gagey N. The hyperabduction test. J Bone Joint Surg Br. 2001;83:69–74.CrossRefGoogle Scholar
  34. 34.
    Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res. 1993;291:7–19.Google Scholar
  35. 35.
    Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18(9):963–75.PubMedGoogle Scholar
  36. 36.
    Speer KP, Hannafin JA, Altchek DW, et al. An evaluation of the shoulder relocation test. Am J Sports Med. 1994;22:177–83.CrossRefGoogle Scholar
  37. 37.
    Kim SH, Park JC, Park JS, Oh I. Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med. 2004;32(8):1849–55.CrossRefGoogle Scholar
  38. 38.
    Kim SH, Park JS, Jeong WK, Shin SK. A novel test for posteroinferior labral lesion of the shoulder—a comparison to the Jerk test. Am J Sports Med. 2005;33(8):1188–92.CrossRefGoogle Scholar
  39. 39.
    Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther. 2016;23:57–68.CrossRefGoogle Scholar
  40. 40.
    Malone AA, Jaggi A, Calvert PT, et al. Muscle patterning instability – classification & prevalence in reference shoulder service. In: Norris TR, Zuckerman JD, Warner JJ, Lee QT, editors. Surgery of the shoulder and elbow: an international perspective. Rosemont: American Academy of Orthopaedic Surgeons; 2006a. section 7.Google Scholar
  41. 41.
    Hegedus FJ, Wright AA, Cook C. Orthopaedic special tests and diagnostic accuracy studies: house wine served in very cheap containers. Br J Sports Med. 2017;51(22):1578–9.CrossRefGoogle Scholar
  42. 42.
    Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46:964–78.CrossRefGoogle Scholar
  43. 43.
    Clark JM, Harryman DT. Tendons, ligaments and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74:713–25.CrossRefGoogle Scholar
  44. 44.
    Ide K, Shirai Y, Ito H, Ito H. Sensory nerve supply in the human subacromial bursa. J Shoulder Elb Surg. 1996;5:371–82.CrossRefGoogle Scholar
  45. 45.
    Lewis JS, Tennent TD. How effective are diagnostic tests for the assessment of rotator cuff disease of the shoulder? In: Evidence based sports medicine. 2nd ed. London: Blackwell Publishing; 2007. p. 327–60.CrossRefGoogle Scholar
  46. 46.
    Barden JM, Balyk R, Raso VJ, Moreau M, Bagnall K. Atypical shoulder muscle activation in multidirectional instability. Clin Neurophysiol. 2005;116(8):1846–57.CrossRefGoogle Scholar
  47. 47.
    Lewis JS. Rotator cuff tendinopathy / subacromial impingement syndrome: is it time for a new method of assessment? Br J Sports Med. 2009;43:259–64.CrossRefGoogle Scholar
  48. 48.
    Watson L, Warby S, Balster S, Lenssen R, Pizzari T. The treatment of multidirectional instability of the shoulder with a rehabilitation programme: Part 1. J Shoulder Elb Surg. 2016;8(4):271–8.CrossRefGoogle Scholar
  49. 49.
    Illyés Á, Kiss RM. Shoulder muscle activity during pushing, pulling, elevation and overhead throw. J Electromyogr Kinesiol. 2005;15:282–9.CrossRefGoogle Scholar
  50. 50.
    Pizzari T, Wickham J, Balster S, Ganderton C, Watson L. Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula. Clin Biomech. 2014;29:201–5.CrossRefGoogle Scholar
  51. 51.
    Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44:300–5.CrossRefGoogle Scholar
  52. 52.
    Willmore EG, Smith MJ. Scapular dyskinesia: evolution towards a systems-based approach. Should Elb. 2016;8:61–70.CrossRefGoogle Scholar
  53. 53.
    Rabin A, Irrgang JJ, Fitzgerald GK, Eubanks A. The Intertester reliability of the scapular assistance test. J Orthop Sports Phys Ther. 2006;36(9):653–9.CrossRefGoogle Scholar
  54. 54.
    Roche SJ, Funk K, Sciascia A, Kibler B. Scapula dykinesis: the surgeon’s perspective. J Shoulder Elb. 2015;7(4):289–97.CrossRefGoogle Scholar
  55. 55.
    Bullock MP, Foster NE, Wright CC. Shoulder Impingement: the effect of sitting posture on shoulder pain and range of motion. Man Ther. 2005;10(1):28–37.CrossRefGoogle Scholar
  56. 56.
    Reddy AS, Mohr KJ, Pink MM, Jobe FW. Electromyographic analysis of the deltoid & rotator cuff muscles in persons with subacromial impingement. J Shoulder Elb Surg. 2000;9:519–23.CrossRefGoogle Scholar
  57. 57.
    Cholewinski JJ, Kusz PJ, Wojgechowski P, et al. Ultrasound measurement of rotator cuff thickness and acromiohumeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2008;16:408–14.CrossRefGoogle Scholar
  58. 58.
    Horsley I, Herrington L, Hoyle R, Prescott E, Bellamy N. Do changes in hand grip strength correlate with shoulder rotator cuff function? J Shoulder Elb. 2016;8(2):124–9.CrossRefGoogle Scholar
  59. 59.
    Konrad GG, Jolly JT, Labriola JE, McMahon PJ, Debski RE. Thoracohumeral muscle activity alters glenohumeral joint biomechanics during active abduction. J Orthop Res. 2006;24(4):748–56.CrossRefGoogle Scholar
  60. 60.
    Itoi E, Newman SR, Kuechle DK, Morrey BF, An KN. Dynamic anterior stabilisers of the shoulder with the arm in abduction. J Bone Joint Surg. 1994;76(5):834–6.CrossRefGoogle Scholar
  61. 61.
    Boettcher CE, Cathers I, Ginn K. The role of the shoulder muscles is task specific. J Sci Med Sport. 2010;13:651–6.CrossRefGoogle Scholar
  62. 62.
    Jaggi A, Noorani A, Malone A, Cowan J, Lambert S, Bayley I. Muscle activation patterns in patients with recurrent shoulder instability. Int J Shoulder Surg. 2012;6:101–7.CrossRefGoogle Scholar
  63. 63.
    Barrett C. The clinical physiotherapy assessment of non-traumatic shoulder instability. J Shoulder Elb. 2015;7(1):60–71.CrossRefGoogle Scholar
  64. 64.
    Mcmullen J, Uhl T. A Kinetic Chain approach for shoulder rehabilitation. J Athl Train. 2000;35(3):329–37.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Huber H, Gerber C. Voluntary subluxation of the shoulder in children: a long-term follow up study of 36 shoulders. J Bone Joint Surg (Br). 1994;76(1):118–22.CrossRefGoogle Scholar
  66. 66.
    Takwale VJ, Calvert P, Rattue H. Involuntary positional instability of the shoulder in adolescents and young adults. J Bone Joint Surg. 2000;82(5):719–23.CrossRefGoogle Scholar
  67. 67.
    Kibler B, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98.CrossRefGoogle Scholar
  68. 68.
    Lhermitte JJ, Bollak NM. Les douleurs à type décharge électrique consécutives à la flexion céphalique dans la sclérose en plaques. Un cas de la sclérose multiple. Rev Neurol. 1924;2:56–7.Google Scholar
  69. 69.
    Spurling RS, Scoville WB. Lateral rupture of the cervical intervertebral discs: a common cause of shoulder and arm pain. Surg Gynecol Obstet. 1944;78:350–8.Google Scholar
  70. 70.
    Adson AW. Surgical treatment for symptoms produced by cervical ribs and the scalenus anticus muscle. Surg Gynecol Obstet. 1947;85:687–700.PubMedGoogle Scholar
  71. 71.
    Gergoudis R, Barnes RW. Thoracic outlet arterial compression: prevalence in normal persons. Angiology. 1980;31:538–41.CrossRefGoogle Scholar
  72. 72.
    Roos DB, Owens JC. Thoracic outlet syndrome. Arch Surg. 1996;93:71–4.CrossRefGoogle Scholar
  73. 73.
    Sanders RJ, Haug CE. Thoracic outlet syndrome: a common sequela of neck injuries. Philadelphia: Lipppincott; 1991. p. 77.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Simon Robinson
    • 1
    Email author
  • Nanette Oakes
    • 2
  • Shantanu Shahane
    • 2
  1. 1.Wirral University Teaching Hospitals NHS Foundation Trust, UptonBirkenheadUK
  2. 2.Chesterfield Royal Hospital, CalowChesterfieldUK

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