Undress the patient – examine for movements _ and examine for asymmetry of the 2 joints – ( the AC joints at are level and clavicles equal ) 
 
Look – 
scars ( from previous surgery ) swellings – Skin changes 
Wasting 
deformity of joint – 
 
look from behind – and examine for wing scapula – by pusshing at the wall ( a pushup ) – – ( Lung Ca – serratus anterior supply damaged ) 
 
feel  – 
for tenderness or swelling of both joints ( from medial scapula to medial – and then at AC joint – check for the bursas ( aorund the area ) + pixon sign ( for AC JOINT OA )  – 
 
Move – stand behind and do all movements  passively holding the shoulder joint 
 
      • then ask to do the joints movement actively  ( Freely ) 
      • then against pressure to do the same movements actively – ( see for pain vs weekness – as weekness more prominant in a tear vs a inflmation in whihch the pain would be prminant – 
special tests  – 
      • Empty can test 
      • Jobs test soon after the empty can test 
      • Applys scrath test – scratch the opposite back of sohulder – from all 3 approaches – COMPARE THE 2 SIDES FROM BACK ) 
      • aprehenshion test –  for stability – ( anterior stability ) – scared pt 
Possibility – 
      • AC joint OA 
      • Rot cuff tear or inflmation – try to recognise if its, sub scapularis, terros minor, supra or infra spinatos, 
      • Bursitis 
      • Calcification of tendons 
      • bicep muscel tear 
      • frozen shoulder 
      • OA of glenoido humoral joint 
 
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