General inspection:

• Observe the patient noting the patient’s posture and any pain, guarding or obvious deformity
• Ask the patient to remove their shirt for adequate exposure. Note any functional limitation as they do so

Inspect

• Compare both sides, inspect anterior, lateral & posterior aspects of the shoulder.
• Symmetry and contours (compare bony prominences looking for obvious deformities or muscular wasting)
• joint swelling (trauma, effusions, joint infections)
• surgical scars, bruising
• scapular position (winging in long thoracic nerve injury)
• First feel for warmth and crepitus. Feel over joints for heat. Have palm of hand on shoulder, passively move pt shoulder through range of motion.
• Examine non affected shoulder first.
• Shoulder droops on dominant side due to more muscle bulk dragging
• Stand naturally. Assess symmetry and balance of shoulders front and back.

Palpate

note tenderness, swelling, temperature changes and crepitus of:

• sternoclavicular joint
• clavicle