Feel

Palpation is of less value in the shoulder than in many other joints. Specific tenderness may be elicited on pressing over the sternoclavicu­lar or acromioclavicular joints, but tenderness around the glenohumeral joint, hidden as it is under the cloak of the acromion and deltoid, is fairly unhelpful.

Subacromial crepitus, as the patient elevates the arm, can often be impressive, particularly in patients with rotator cuff tears. Some surgeons can feel the defect of a rotator cuff tear with the arm in an extended and adducted position when the impingement area of supraspinatus insertion is brought out from under the acro­mion, but this requires great experience.

Clicking or snapping should be felt in an attempt to locate the structure from which it emanates. A snapping scapula may be associ­ated with osteochondroma of the blade of the scapula clunking over the ribs as the arm elevates. Clicking on instability testing or eleva­tion may be due to subluxation or a labral tear.