An examination already begins during a patient's
taking off, which is the best opportunity for a doctor to watch a functional
restriction of movements, mainly during a pulling of clothes over his/her hand.
During the examination deformities of contours of the shoulder girdle can be
obvious, especially at serious states.
a fracture of the clavicle or the humerus
bursitis which changes a contour of the shoulder when there is a bigger filling1
atrophy of muscles, distinctly more visible at neurological affections than at the affection of the rotator cuff2 by rheumatoid processes. There occurs atrophy only at ruptures of the rotator cuff
a luxation of the shoulder joint
haematoma : often at eventual ruptures of muscles
arthrotic changes in the area of the sternoclavicular articulation
a luxation of the acromioclavicular articulation
a lump of the arm during an active contraction of m. biceps at its rupture
a sticking out of the scapula during a press-up against the wall can occur in the case of a weakness of m. serratus anterior, f. e. caused by paresis of n. thoracicus longus3
an enlargement of the sternoclavicular articulation at the articular instability. The sternoclavicular articulation should be watched at maximal abduction. An excessive enlargement of this articulation shows a laxity of the sternoclavicular articulation and its ligamentous apparatus.
If we stand behind the patient, we can watch , except
the extension of the movement, a scapulohumeral and scapulothoracal rhythm
during the examination of complex
movements of the limb4. The rhythm is in the case of a disorder, mainly
glenohumeral articulation, violated, and at the elevation of the limb the
patient compensates the disorder of motility by an excessive movement of the
scapula, and so the extension of elevation does not have to be restricted at the
In the area of the shoulder girdle we find an instability mainly of the glenohumeral articulation. With regarding to its meaning, therefore the instability of the glenohumeral articulation is described independently. We can meet the same cause of the problems at the sternoclavicular and acromioclavicular joint.
1But patient notices the
oedema of the shoulder, and he/she talks about as a symptom even if quantity of
the liquid is minimal, mostly with words: I think that my shoulder is swollen
even if I cannot see anything.
2except ruptures of the
3so-called scapula alata
4i. e. an elevation
in abduction and in flexion