At the end of the chapter about the examination and cinesiology of the shoulder girdle we have to stress that the examination of the extension of the movement has its meaning rather for watching of the state than for adequate differential diagnostics. The restricted extension of isolated movements in the glenohumeral articulation is a clear symptom of the affection of the structures in its area. On the other hand, a normal finding at the examination of complex movements of the shoulder girdle shows a normal state of the whole shoulder girdle.
In the case that pain occurs during complex movements, we examine the movement in the glenohumeral articulation, and mainly the outer rotation (see capsule pattern) to be able to find the restriction of the extension of the movement connected only with serious states which can proceed very slowly and without any symptoms, and a doctor, who underestimates patient's problems, is surprised with a finding of a restricted motility after some time. On the other hand, we have to stress that in the case of rheumatoid processes, the restriction of the extension of the movement does not occur at the first place, and therefore this examination does not give evidence about weightiness of the affection. Rheumatoid problems begin with a resting night pain, a morning stiffness and with pains during active movements. Also an extensive finding (showed at the ultrasound examination) do not have to be in connection with the expressive restriction of motility in the case of acute origin. During watching of a rheumatoid patient in practice it is necessary to ask exact questions about typical pains of the shoulder at the affection of synovial structures at first, and then to make the examination of combined movements which will check up the functionality and absence of pathological process in more structures.