A Step-by-Step Breakdown with Dr. Matt DiPaola
Understanding your shoulder condition starts with a thorough physical exam. In this instructional video, Dr. Matt DiPaola demonstrates how an orthopedic shoulder specialist approaches a shoulder exam to diagnose problems with accuracy and clarity. If you are a medical professional learning the fundamentals or a patient preparing for your visit, this video provides valuable insight into the comprehensive approach used in shoulder evaluations.
What to Expect During a Shoulder Exam
Dr. DiPaola walks viewers through the typical shoulder physical exam, breaking it down into logical steps:
Visual Inspection
The first step is assessing the shoulder’s appearance. Dr. DiPaola emphasizes looking for asymmetry, muscle atrophy (especially in the infraspinatus region), and abnormalities in shoulder contour from both the front and back. Proper exposure—such as wearing a tank top—helps ensure an effective visual exam.
Palpation
By gently pressing along the collarbone, shoulder joint, and surrounding musculature, Dr. DiPaola evaluates for tenderness, swelling, or structural irregularities. This can help identify issues in the AC joint, biceps tendon, supraspinatus, and pectoralis major.
Range of Motion
Dr. DiPaola examines movement in several planes to identify stiffness, pain, or restriction. Movements assessed include:
- Forward flexion
- External rotation (at side and in abduction)
- Internal rotation (behind the back using vertebral levels as a marker)
Strength Testing
Each rotator cuff muscle is tested in a specific position to isolate it:
- Supraspinatus: “Empty can” test in scapular plane
- Infraspinatus: External rotation with resistance at the side
- Teres Minor: Resistance in full abduction and external rotation
- Subscapularis: Belly press test, lift-off test, and bear hug test
Special Tests for Diagnosis
Several orthopedic maneuvers help pinpoint the source of shoulder pain:
- Neer and Hawkins Tests: Assess for impingement
- Speed’s Test: Evaluates biceps tendon irritation
- O’Brien’s Test: Screens for SLAP tears or AC joint pain
- Cross-Body Adduction Test: Localizes AC joint pathology
- Labral Shear Test: Detects labral tears with deep clicking or pain
- Apprehension and Relocation Tests: Identify shoulder instability
Why This Matters
Dr. DiPaola stresses the importance of aligning the physical exam with the patient’s unique complaints. While imaging can be useful, it’s the clinical exam that often provides the most immediate and accurate diagnostic clues. This approach helps avoid unnecessary testing and ensures a treatment plan that’s targeted and effective.