An OSCE (Objective Structured Clinical Examination) for the shoulder joint involves a systematic approach to examining the shoulder. A step-by-step guideline includes inspection, palpation, range of motion (ROM), and special tests.
1. Introduction and Preparation
- Introduce yourself to the patient.
- Confirm the patient’s identity and obtain consent.
- Explain the procedure to the patient.
- Ensure the patient is appropriately undressed to expose the shoulder area for a proper examination.
2. Inspection
- Observe the general appearance of the shoulder region.
- Look for any swelling, asymmetry, deformity, muscle wasting, scars, or skin changes
- Inspect from the front, side, and back.
3. Palpation
- Palpate for tenderness starting from the sternoclavicular joint, moving along the clavicle to the acromioclavicular joint, and then along the scapula and spine of the scapula
- Palpate the greater tuberosity of the humerus, the bicipital groove, and the rotator cuff tendons
- Check for temperature differences which may indicate inflammation.
4. Range of Motion (ROM)
- Active Range of Motion (AROM): Ask the patient to perform the following movements:
- Flexion: Raise the arm forward.
- Extension: Move the arm backward.
- Abduction: Lift the arm sideways.
- Adduction: Bring the arm across the body.
- Internal rotation: Place the hand behind the back.
- External rotation: Place the hand behind the head.
- Passive Range of Motion (PROM): If active ROM is restricted, perform the movements passively.
5. Strength Testing
- Assess the strength of the shoulder muscles using resisted movements:
- Resisted abduction: Deltoid muscle.
- Resisted external rotation: Infraspinatus and teres minor muscles.
- Resisted internal rotation: Subscapularis muscle.
6. Special Tests
- Neer’s Test: For impingement.
- Stabilize the scapula and passively flex the arm.
- Hawkins-Kennedy Test: For impingement.
- Flex the shoulder and elbow to 90 degrees, then internally rotate.
- Drop Arm Test: For rotator cuff tear.
- Abduct the arm to 90 and ask the patient to slowly lower it.
- Apprehension Test: For anterior shoulder instability.
- Abduct and externally rotate the arm, apply anterior pressure.
- Sulcus Sign: For inferior instability.
- Pull the arm downward and observe for a sulcus below the acromion.
- Speed’s Test: For bicipital tendinitis.
- Resist shoulder flexion while the arm is extended and supinated.
- O’Brien’s Test: For labral tears.
- Flex the arm to 90 degrees, adduct, and internally rotate; apply downward force.
7. Conclusion
- Thank the patient and offer to help them dress if necessary.
- Summarize findings to the patient if appropriate.
- Documentthe examination findings.
This structured approach ensures a comprehensive examination of the shoulder joint during an OSCE.
