Physical Examination 209: Shoulder Complex

The examination of the shoulder complex as a chiropractor performs and documents it: consultation and history; clearing the cervical spine with range of motion and Spurling's test; visual inspection, palpation and active range of motion; the glenohumeral instability tests — sulcus sign (grades I–III), hyperabduction, apprehension, relocation, anterior release and load and shift (grades 0–3); acromioclavicular separations by degree and mechanism and the crossover, painful arc, compression and AC resisted extension tests; the range-of-motion pattern of adhesive capsulitis; internal versus external impingement; the posterior impingement, scapular pinch, anterior slide, Codman's drop arm, empty can (Jobe's), external rotation lag, Hornblower's, Gerber lift-off, Neer, Hawkins-Kennedy and Kibler scapular retraction tests and the bench press maneuver — each with position, procedure, positive finding and indication; and manual muscle testing with the 0–5 scale and the trapezius. The key tests are demonstrated on video.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a repeatable, documentable shoulder examination: the order of the sequence, the tests grouped by what they find, and for each one the positive finding and the structure it points to.

By letting the tests sort it, which is what the course teaches test by test — after the neck has been cleared first, since a cervical problem can masquerade as a shoulder one. Instability shows itself when the humeral head moves more than it should: a visible sulcus below the acromion when the arm is pulled down, apprehension when the arm is taken into abduction and external rotation that eases when the examiner pushes the humeral head back, or excess translation on the load and shift test. Impingement shows itself as pain in a position — pain past ninety degrees on the Neer test, pain with internal rotation on Hawkins-Kennedy, and a Kibler test in which stabilizing the scapula lets the arm go further without pain. A torn rotator cuff tendon shows itself as weakness or a lag: the arm that cannot be lowered slowly from full abduction (Codman's drop arm) or gives way on the empty can test points to the supraspinatus, an arm that drifts back into internal rotation after the examiner lets go points to the infraspinatus (external rotation lag sign) or the teres minor (Hornblower's sign), and the hand that cannot lift away from the lower back points to the subscapularis (Gerber lift-off). Deep posterior pain on the posterior impingement test points to internal impingement, a painful click on the anterior slide test to a SLAP tear, and pain on the crossover test or compression to the acromioclavicular joint. The pattern across the tests, not any one of them, makes the call.

Physical Examination 209 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's Adjusting & Manual Therapy 203: Shoulder Treatment Techniques is the treatment half of the same region — 209 is the examination, that course is the adjusting and manual therapy. His Physical Examination 205: Cervical Spine is the natural companion, because the shoulder exam opens by clearing the neck; add his 207: Thoracic Spine and Rib Cage or 208: Lumbar Spine & Sacroiliac Joints and the three courses are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). Dr. O'Hara's Physical Examination 202: Neck and Upper Extremities approaches the shoulder from the injury-pattern and imaging side, and many clinicians take both. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.