Summary of Common Conditions Seen in OSCEs
| Condition | History | Symptoms and signs |
| Most common conditions | ||
| Adhesive capsulitis (frozen shoulder) | Two phases: pain, then stiffness Common in diabetics and middle-aged patients (age around 50 years) Lasts about 18 months Pain often worse at night | Pain in all directions of movement Worse on external rotation |
| Rotator cuff impingement (supraspinatus tendonitis) | Pain on abduction | Pain on abduction in characteristic ‘arc’ (70–120 degrees) |
| Rotator cuff tear | Trauma Cannot lift objects above head | Pain on abduction in characteristic arc (70–120 degrees) Pain worse on resisted abduction Active movements more painful than passive movements |
| Others – inflammatory/degenerative | ||
| Biceps tendonitis | Anterior shoulder pain Pain lifting heavy objects | Tenderness at bicipital groove upon palpation |
| Calcific tendonitis | Three different presentations:
| Stiffness, weakness, crepitus. Radiation of pain from shoulder tip to deltoid insertion Decreased range of movement, painful arc 70–120 degrees Pain on abduction of shoulder or lying on shoulder |
| Acromioclavicular joint arthritis | Decreased range of movement Pain at tip of shoulder Pain on overhead lifting | Pain with cross-body movements Tenderness upon palpation at the acromioclavicular joint |
| Rotator cuff tendonitis | Pain over shoulder at night | Painful arc relieved by external rotation, worsens with internal rotation |
| Others – conditions causing instability | ||
| Acute anterior dislocation | Trauma Decreased range of movement | Humeral head projects anteriorly Axillary nerve palsy Deltoid muscle dysfunction |
| Acute posterior dislocation | Seizures Elderly Electric shock | Limitation of external rotation |
| Recurrent shoulder instability | Young Trauma Joint laxity: Ehlers–Danlos syndrome | Examine other joints for laxity, including hands, elbows and knees Sulcus sign Load shift sign |
Hints and Tips for the Exam
Know Your Scars
Upon inspecting the patient, you may be faced with a multitude of scars, the indications for which may help with your diagnosis.
| Scar | Location of incision | Indication |
| Anterior | Lateral side of clavicle downwards following medial border of deltoid muscle | Shoulder replacement Open reduction/internal fixation of fracture of humerus |
| Posterior | Along border of scapular spine | Fractures of scapula or glenoid neck Posterior stabilisation surgery |
| Superior strap | Lateral to the border of the acromion | Rotator cuff surgery |
| Arthroscopy portals (Figure 17.1) | Through deltoid and posterior lateral edge of acromion | Adhesive capsulitis Loose bodies Chronic synovitis Impingement syndrome: rotator cuff tears and tendonitis Osteoarthritis Shoulder instability |
Know Your Muscle Groups
The following muscles are responsible for the movements elicited within the shoulder examination.
| Movement | Muscle |
| Flexion | 0–60 degrees
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