Shoulder OSCE Examination Quiz

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What is the most appropriate way to finish a shoulder examination?

Thank the patient and ask them to dress, wash your hands, summarise your findings, examine the neck and elbow, check the nerves, circulation and function of the arm, and consider relevant imaging. Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the opposite shoulder for comparison. Thank the patient, ask them to dress, wash your hands, summarise your findings, and request an urgent CT scan of the shoulder before examining the neck and elbow. Thank the patient, wash your hands, summarise your findings, and finish once active and passive shoulder movements have been tested. Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the wrist and hand for referred pain before considering relevant imaging.

A Thank the patient and ask them to dress, wash your hands, summarise your findings, examine the neck and elbow, check the nerves, circulation and function of the arm, and consider relevant imaging. ✓
B Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the opposite shoulder for comparison.
C Thank the patient, ask them to dress, wash your hands, summarise your findings, and request an urgent CT scan of the shoulder before examining the neck and elbow.
D Thank the patient, wash your hands, summarise your findings, and finish once active and passive shoulder movements have been tested.
E Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the wrist and hand for referred pain before considering relevant imaging.

The answer is A: Thank the patient and ask them to dress, wash your hands, summarise your findings, examine the neck and elbow, check the nerves, circulation and function of the arm, and consider relevant imaging.

Explanation

Why A is correct

See Move (Range of Movement). Option A is correct because finishing a shoulder examination has three parts. First comes patient-centred closure: thank the patient, ask them to dress and wash your hands. Second, summarise your findings. Third, state what else you would examine. You would examine the neck and the elbow, because the joints above and below a painful joint can refer pain to it; in particular, problems in the cervical spine (the neck bones) can irritate nerve roots and cause pain felt in the shoulder, and a shoulder problem can be mistaken for a neck one. You would also check the nerves, circulation and function of the arm (a neurovascular assessment), for example to look for nerve injury or reduced blood flow, and consider relevant imaging, such as an X-ray, guided by what you found. This turns a list of signs into a safe clinical plan and shows the examiner that you think beyond the joint in front of you.

Closure: Thank the patient, ask them to dress and wash your hands.
Summary: Summarise your findings and state what else you would examine.
Further assessment: The neck, the elbow, a neurovascular assessment and imaging if needed.

Why the other options are incorrect

B. Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the opposite shoulder for comparison.: Examining the opposite shoulder for comparison is useful, but finishing there omits the neck, elbow, neurovascular assessment and imaging that complete the examination.
C. Thank the patient, ask them to dress, wash your hands, summarise your findings, and request an urgent CT scan of the shoulder before examining the neck and elbow.: An urgent CT scan is not a routine completion step; imaging should be guided by the clinical findings after the neck, elbow and neurovascular assessment have been completed.
D. Thank the patient, wash your hands, summarise your findings, and finish once active and passive shoulder movements have been tested.: Active and passive movements are part of the shoulder examination, but stopping after them leaves out the neck, elbow, neurovascular check and imaging that complete the assessment.
E. Thank the patient, ask them to dress, wash your hands, summarise your findings, and examine the wrist and hand for referred pain before considering relevant imaging.: The wrist and hand are below the shoulder and are not the standard neighbouring joints to examine here; the neck and elbow are the joints above and below that can refer pain, and the neurovascular assessment is still needed.

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More questions from this set. Start the quiz to answer them and see each explanation.

1
A 52-year-old woman has shoulder pain when reaching for a high shelf. After checking for pain and obtaining consent, you observe active abduction. Pain appears between about 60 and 120 degrees, then eases as the arm reaches overhead. Passive range is nearly full. Which region is most strongly implicated by this pattern?
2
During a shoulder OSCE examination, you ask a consenting patient to place a hand behind the back and move the thumb as far up the spine as comfortably possible. You record the highest vertebral level reached and compare sides. This is the standard functional assessment of which shoulder movement?

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