Shoulder, arm and wrist

When completing an MSK limb assessment always compare with the uninjured/opposite limb to gauge the patient’s norm.

Always assess above and below injured area as good practice.

Consider pmhx of similar injury or illness to the limb being assessed i.e. repetitive injuries, previous surgeries etc.

Inspect:

Wounds, swelling, deformity, scarring, bruising, rashes, exudate.

Assessment:

Range of movement including rotation, flexion, extension.

Assess movement:

Passively (pt does all movement on their own)

Assistive (Assist without force the motions)

Resistive (Movement against resistance applied by the clinician assessing)

Assess sensation - (always assess in comparison with uninjured/opposite limb)

Assess circulation – Pulses (bilaterally) distal to the injury. Colour and capillary refill.

Sensation - Any numbness/reduced or altered sensation/parasthesia

Shoulder – Regimental badge sign (region) as well as shoulder blade and down rest of arm, down to fingers.

Elbow – Around injury, up and down arm, down to fingers.

Hand – Above injury, down fingers (three nerves: median, ulnar, and radial)

Palpation of and around injury:

Shoulder – Palpate scapula, clavicle, humeral head, humerus.

Elbow – Palpate olecranon, epicondyle.

Wrist – Palpate radius, ulnar.

Hand – Palpate (scaphoid – see below), trapezoid, trapezium, capitate, hamate, pisiform, triquetrum, lunate and along the metacarpal bones.

Always palpate bones above and below injured area as well.

Fall with outstretched hand? Wrist/Hand injury?Consider Scaphoid #:

Rotate/telescope the thumb

Palpate for tenderness on the “anatomical snuffbox”

Range of movement of each digit (fingers to thumb).