A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff

Abstract

A thorough physical examination of the shoulder and cervical spine is critical in establishing a focused differential diagnosis of the pathology in and around the shoulder joint. Numerous tests have been described in the literature to help improve the diagnostic accuracy of specific shoulder or cervical spine pathology. A comprehensive approach for the physical examination of the cervical spine, scapula, and rotator cuff is presented and descriptions on how the tests are performed and the evidence behind why specific tests are used in enabling improved diagnosis of shoulder pathology are discussed.

The Virtual Shoulder and Knee Physical Examination

“…28,68,69 When a patient presents with undifferentiated shoulder and neck pain, it is important to rule out a neurological or cervical cause of the patient's symptoms. 28,29,76 The Spurling test can be helpful in suggesting a diagnosis of cervical disc disease. 28,68,69 The shoulder exam can be broadly divided into a core exam and abnormality-specific special testing.…”

“…28,29,76 The Spurling test can be helpful in suggesting a diagnosis of cervical disc disease. 28,68,69 The shoulder exam can be broadly divided into a core exam and abnormality-specific special testing. The core exam includes an overall inspection, assessment of the localization of pain, range of motion testing, motor testing, sensory testing, and peripheral vascular exam.…”

“…Abnormality-specific special testing can be subdivided into impingement/rotator cuff injury, glenohumeral instability, acromioclavicular (AC) joint arthrosis, biceps-labrum complex (BLC) disease, thoracic outlet syndrome, and generalized ligamentous laxity. 28,29,66,67 Most special tests can be completed independently by the patient with only minor alterations to the originally described techniques ( Figure 2).…”

“…A useful screening tool for identifying AC joint injuries is the assessment of tenderness to palpation over the AC joint, which may be performed by the patient using the contralateral hand. [26][27][28]66,74 The crossbody adduction test can also be performed independently by the patient. 12,26,27,74 The Speed and Yergason tests are good confirmatory tests for proximal biceps injuries that can be modified to be performed entirely by the patient.…”

“…38,44,48,62 One common stance was that musculoskeletal telehealth visits are limited without an in-person physical examination. 9,28,29,66,67 Although 1 recently published study described basic physical examination components, 62 to our knowledge, we provide below the first comprehensive description of a shoulder and knee physical examination for telehealth purposes.…”