Shoulder Joints: Self-Examination, Assessment, and When to Seek Help

How do you examine your shoulder joints?

Examining your shoulder joints involves a systematic self-assessment of visual cues, range of motion, basic strength, and the presence of any pain or unusual sensations to identify potential issues or track progress in shoulder health.

Introduction to Shoulder Joint Examination

The shoulder joint, a marvel of anatomical design, boasts the greatest range of motion of any joint in the human body. This mobility, however, comes at the cost of inherent instability, making it susceptible to a wide array of injuries and dysfunctions. For fitness enthusiasts, personal trainers, and student kinesiologists, understanding how to perform a basic, non-diagnostic examination of the shoulder is crucial. This self-assessment serves as an early warning system, helps monitor recovery, and informs training modifications, but it is never a substitute for professional medical diagnosis.

Foundational Principles of Shoulder Assessment

A thorough examination, even a self-one, relies on observing several key parameters:

• Symmetry: Are both shoulders presenting similarly in terms of muscle bulk, position, and movement?
• Range of Motion (ROM): Can the joint move freely through its full physiological limits without restriction or pain? Differentiating between active ROM (you move it yourself) and passive ROM (someone else moves it for you) can provide insights into muscle vs. joint limitations.
• Strength: Is there adequate muscle strength to perform movements against gravity and light resistance?
• Pain & Sensation: Is there any discomfort, clicking, grinding, numbness, or tingling during movement or at rest? Note the location, quality, and intensity.
• Stability: Does the joint feel secure and controlled throughout its range, or is there a sense of apprehension or looseness?

Visual Inspection: What to Look For

Begin your examination by standing in front of a mirror, observing your shoulders from the front, side, and back.

• Posture: Observe your resting posture. Are your shoulders rounded forward? Is one shoulder higher than the other? Do you have a forward head posture? These can indicate muscle imbalances or habitual patterns affecting shoulder mechanics.
• Muscle Atrophy/Hypertrophy: Look for noticeable differences in muscle size between your left and right shoulders. Specifically, check the deltoids (shoulder cap), and the areas above (supraspinatus fossa) and below (infraspinatus fossa) the spine of your scapula for any hollowing or asymmetry, which might suggest rotator cuff issues.
• Scapular Position and Movement (Scapular Dyskinesis):
  • At rest, observe if your shoulder blades lie flat against your rib cage. Winging (the medial border or inferior angle of the scapula protruding) is a common sign of weakness in stabilizing muscles like the serratus anterior.
  • As you move your arms, watch how your scapulae move. Do they move smoothly and synchronously, or do they "hitch," "jump," or move excessively in one direction (e.g., shrugging excessively during arm elevation)?
• Bony Landmarks: Visually inspect for any obvious deformities, swelling, or prominence of bony structures like the clavicle (collarbone) or acromion (outer part of the shoulder blade).

Assessing Range of Motion (ROM): Key Movements

Perform these movements slowly and deliberately, noting any pain, clicking, or limitations compared to the other side or your normal range.

• Shoulder Flexion: Stand tall. Raise your arm straight forward and overhead, keeping your elbow straight, as if reaching for the sky. Observe how high you can go. Normal is typically 170-180 degrees.
• Shoulder Extension: Stand tall. Reach your arm straight back behind you, keeping your elbow straight. Normal is typically 50-60 degrees.
• Shoulder Abduction: Stand tall. Raise your arm straight out to the side and overhead, like making a "jumping jack" motion. Normal is typically 170-180 degrees.
• Shoulder Adduction: Bring your arm across the front of your body towards the opposite shoulder. Normal is typically 40-50 degrees.
• External Rotation:
  • At 90 degrees Abduction (or Scaption): Lie on your back or stand. Bring your arm out to the side so your upper arm is parallel to the floor and your elbow is bent to 90 degrees, forming an "L" shape. Keeping your upper arm stable, rotate your forearm upwards so your hand moves towards your head. Normal is typically 80-90 degrees.
  • At 0 degrees Abduction (Arm at Side): With your elbow bent to 90 degrees and tucked into your side, rotate your forearm outwards. Normal is typically 50-60 degrees.
• Internal Rotation:
  • At 90 degrees Abduction (or Scaption): From the "L" shape position, rotate your forearm downwards so your hand moves towards your feet. Normal is typically 70-80 degrees.
  • Arm Behind Back: Reach your hand behind your back as high as possible, aiming to touch your opposite shoulder blade. Note which vertebra you can reach with your thumb. Normal is typically around T7-T9.
• Scaption (Scapular Plane Abduction): Raise your arm forward and slightly out to the side (about 30-45 degrees from the front), straight overhead. This movement is often less impingement-prone than pure abduction and reflects functional movement.

Basic Strength & Stability Checks

These are not maximal strength tests but rather checks for basic muscular integrity and control.

• Isometric Holds (Against Light Resistance):
  • Flexion: Place your other hand on top of your raised arm (at about 90 degrees flexion) and try to push down while resisting.
  • Abduction: Place your other hand on the outside of your arm (at about 90 degrees abduction) and try to push in while resisting.
  • External Rotation: With your elbow bent to 90 degrees and tucked in, place your other hand on the outside of your forearm and try to push in while resisting.
  • Internal Rotation: With your elbow bent to 90 degrees and tucked in, place your other hand on the inside of your forearm and try to push out while resisting.
  • Observe for: Pain, significant weakness, or inability to hold.
• Push-up Plus: Perform a push-up. At the top of the movement, push through your hands further, rounding your upper back slightly and protracting your shoulder blades. This tests serratus anterior strength and scapular control.
• Wall Slides/Scapular Retractions: Stand with your back against a wall, arms bent at 90 degrees like a goalpost. Slowly slide your arms up the wall, keeping your forearms, elbows, and wrists in contact. This assesses scapular upward rotation and stability.

Listening to Your Body: Pain & Sensation Cues

Pay close attention to any discomfort or unusual sensations during your examination.

• Location: Pinpoint exactly where you feel the pain (e.g., front of the shoulder, top, back, deep inside, radiating down the arm).
• Type: Describe the pain (e.g., sharp, dull ache, burning, throbbing, clicking, grinding, popping).
• Timing: Does it hurt only with certain movements, at the end of the range, at rest, or at night?
• Radiation: Does the pain travel down your arm, up your neck, or into your hand? This could indicate nerve involvement.
• Associated Symptoms: Any numbness, tingling, weakness, or feeling of instability or "giving way"?

When to Seek Professional Guidance

While self-examination is valuable for awareness, it cannot diagnose an injury or condition. It is imperative to consult a healthcare professional (e.g., doctor, physical therapist, sports medicine specialist) if you experience any of the following:

• Persistent pain that doesn't improve with rest or minor adjustments.
• Significant loss of range of motion or strength that impacts daily activities or training.
• Visible deformity, swelling, or bruising after an injury.
• Numbness, tingling, or weakness in the arm or hand.
• Acute, sharp pain that prevents movement.
• A feeling of instability or dislocation.

Conclusion: Proactive Shoulder Health

Regularly examining your shoulder joints is a proactive step in maintaining their health and optimizing your physical performance. By understanding your body's baseline, you can quickly identify deviations, address minor issues before they escalate, and make informed decisions about your training. Remember, this examination is a tool for self-awareness and preliminary assessment. Always prioritize professional medical advice for diagnosis and treatment of any significant shoulder concerns.