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Examination of the bones & Joints of the Upper Limb
Understand the concepts & associated principles, functional & clinical anatomy underlying the
physical examination of the shoulder joint.
Introduction to the shoulder: some basic concepts
Bones of the Shoulder:
Surface Landmarks of the Shoulder and Arm:
Palpable Bony Landmark Structures:
Clavicle: visible and palpable throughout its course. Its outline can be traced from the
expanded sternal end, which forms the lateral boundary of the suprasternal notch, to the
flattened acromial extremity.
Acromioclavicular joint- palpable as a distinct 'step' in an anteroposterior plane.
Acromion - can be traced from the acromioclavicular joint laterally to its tip, and then
posteriorlly across the top of the shoulder until it meets the crest of the spine of the scapula at
the prominent acromial angle.
Spine of the scapula - palpated as it passes medially from the acromial angle to the medial
(vertebral) border of the scapula, where it lies opposite the spine of T3 vertebra. The spine is
subcutaneous and is easily visible in a thin subject.
Medial border of the scapula - is hidden in its upper part by trapezius, but below T3 it can be
palpated as it passes downwards to the inferior angle of the scapula.
Inferior angle of the Scapular- Although covered by teres major and latissimus dorsi, the
inferior angle can easily be felt when it is approached from below, and it can be seen to move
in an arch laterally and forwards around the chest wall when the arm is raised above the head.
The inferior angle of the scapula is at the level of T7 vertebra and overlies rib 7.
Clinical note: When a thoracotomy is being performed, it is a convenient landmark from
which the ribs can be counted along the lateral chest wall.
Infraclavicular fossa- (or deltopectoral triangle) A small depression can be seen inferior to the
clavicle at the junction of its convex medial and concave lateral portions (pointy bit in the
middle of the shaft). The medial boarder is an elevation made by the origin of pectoralis major,
laterally, by the origin of deltoid.
Clinical note: The brachial plexus passes below the fossa, as does the axillary artery.
Apex of the coracoid process -lies 2.5 cm below the acromioclaviclular joint -under the
anterior fibres of deltoid.
Lesser tubercle of the head of humorous -If the examining finger is passed laterally from the
coracoid process, the lesser tubercle of the humerus will be felt below the tip of the acromion
on deep pressure through deltoid. This bony prominence slips away from the examining finger
when the humerus is rotated laterally or medially (WOW – I can feel it, it works!!!).
Greater tubercle of the humerus - is the most lateral bony point in the shoulder region and
projects laterally below and in front of the acromial angle. It can also be felt to move on
rotation of the humerus. Head of the humerous- When the arm is abducted, the head of the
humerus can be palpated on deep pressure in the apex of the axilla (not convinced- there’s
too much going on down there.)