UPPER EXTREMITIES

• SHOULDERS

  Inspect and compare both shoulders anteriorly and posteriorly.
• SHOULDERS

  Check the size and contour of the joints and compare shoulders for equality of bony landmarks.
• ABNORMAL FINDINGS OF SHOULDER:

  • Redness
  • Unequal bony landmarks.
  • Muscle atrophy.
• Swelling from excess fluid (best seen anteriorly).
• Palpate both shoulders. Start at the clavicle and explore the acromioclavicular joint, scapula, greater tubercle of the humerus, area of the subacromial bursa, the biceps groove, and the anterior aspect of the glenohumeral joint.
• ABNORMAL FINDINGS OF SHOULDERS:

  • Swelling.
  • Hard muscles with muscle spasm.
  • Tenderness or pain.
• With arms at sides and elbows extended, move both arms forward and up in wide vertical arcs, then move them back.

  NORMAL FINDINGS:

  • Forward flexion of 180 degrees.
  • Hyperextension up to 50 degrees.
• Rotate arms internally behind back, place back of hands as high as possible toward the scapulae.

  NORMAL FINDINGS:

  • Internal rotation of 90 degrees.
• With arms at the sides and elbows extended, raise both arms in wide arcs (abduction). Touch palms together above head (adduction).

  NORMAL FINDINGS:

  • Abduction of 180 degrees.
  • Adduction of 50 degrees.
• Touch both hands behind the head with elbows flexed and rotated posteriorly (external rotation of shoulders)

  NORMAL FINDINGS:

  • External rotation of 90 degrees.
  • Then, test strength of the shoulder muscles by asking the person to shrug the shoulders, flex forward and up, and abduct against resistance.
  • The shoulder shrug also tests the function of Cranial Nerve XI (spinal accessory).
• ELBOWS

  • Inspect the size and contour of the elbows in both flexed and extended positions.
• ELBOWS

  • Assess for any deformity, redness or swelling.
• ELBOWS

  • Check the olecranon bursa and the hollows on either side of the olecranon process and the medial and lateral epicondyles of humerus - with the right thumb and fingers.
• ELBOWS

  • With the thumb in the lateral groove and the index and middle fingers in medial groove, palpate either side of the olecranon process using the varying pressure.