Inspection

Inspection of the shoulder joint is the first step in examination. There should be careful comparison with the opposite side. Points of note include:

• initial inspection:
  • discolouration e.g. erythema
  • abrasions
  • scars
  • asymmetry
• position arm held in e.g. adduction with arm held across anterior chest
• clavicle:
  • absence; shoulders appear rounded
  • altered smooth contour of shaft - possible fracture
  • overriding at either end - dislocation
• deltoid muscle:
  • normally smooth, symmetrical contour to lateral aspect of shoulder
  • prominence of greater tuberosity of humerus - wasting of deltoid
  • dimpling of contour below acromion laterally - possible dislocation with arm held in abduction
• presence of deltopectoral groove delineating the interface of deltoid and pectoralis major
• scapula:
  • triangular in shape
  • vertebral border approximately 3-4 cm from spinous processes
  • covering ribs 2-7 posteriorly
  • spine of scapula roughly at level of T3
  • inspection may reveal Sprengel's deformity or winging
• spine:
  • scoliosis
  • kyphosis
• movement with gait; the arm should swing in unison with the opposite lower limb