Swelling, deformity or subluxation of the ster­noclavicular, acromioclavicular or glenohume-ral joints are noted, as are any swellings or deformity of the clavicle, humerus or scapula. The appearance of the skin is noted, and in particular any scars or incisions are inspected.

Muscle-wasting is of particular importance to the shoulder (Figures 2.8 and 2.9). The rotator cuff has been likened to the quadriceps, in that both have four muscle bellies (subscapu)aris, supraspinal, infraspinatus and teres minor) and both waste rapidly with any abnormality of their associated joint. Wasting of supraspinal and infraspinatus is easily seen and can be compared to the normal side. The thickness of the muscle and the tone in it can also be felt.

If wasting is extreme, then neuromuscular disease should be considered. Fascioscapulo-humeral dystrophy often presents with toss of shoulder function, with marked proximal muscle wasting. Scapular winging may be the presentation of neuralgic amyotrophy. Marked and isolated wasting of supraspinatus and infraspinatus may point the way to a diagnosis of suprascapular nerve entrapment syndrome.

Figures 2.8 and 2.9 Wasting of the cuff muscles, moderate (2.8) and gross (2.9) following rotator cuff tears of long standing.

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