Pediatric Orthopaedic Exams: The Upper Extremities

Lawrence Wells, MD, Orthopaedic Surgeon and sports medicine specialist at Children's Hospital of Philadelphia (CHOP), demonstrates how to properly perform an exam of the upper extremities on a pediatric patient. Dr. Wells provides guidance on effectively evaluating patients for rotator cuff injuries, fractures of the proximal humerus and clavicle, overuse injuries, and more.


Pediatric Orthopaedic Exams: The Upper Extremities

Lawrence Wells, MD: Good morning. I'm Dr. Wells from The Children's Hospital of Philadelphia, Department of Orthopaedic Surgery. Let me wash my hands, or Purell them. Stewart, how're you doing?

Stewart, patient: Good.

Dr. Wells: So we're here to talk about your shoulder today.

Stewart: Yeah.

Dr. Wells: I understand that you injured it. With?

Stewart: A soccer ball hit me in my last soccer game.

Dr. Wells: Where did it hit you?

Stewart: Like right here.

Dr. WellsOK. Well, let's start out with the exam. First and foremost, does your neck hurt?

Stewart: Only a little. Like right around here.

Dr. Wells: OK. Well let's look at the ceiling. All right. And then look to the right, and now look to the left. Does that bother you at all?

Stewart: Only like right here.

Dr. Wells: OK. Now, tell me as I push down on your head, does that bother you?

Stewart: No.

Dr. Wells: As I tap, does that bother you?

Stewart: No.

Dr. Wells: OK. Very good. So now let's come here to the AC joint. This is the spot that typically hurts the most common. Right here, your AC joint. So let's push on your AC joint. Does that hurt right there?

Stewart: Yes.

Dr. Wells: OK. How about your coracoid process?

Stewart: No.

Dr. Wells: So I typically try and find the area that hurts the most. And Stewart, point to it again. OK. Very good. All right. So now let's conduct the exams.

Stewart, we need to see what your motion is like. So let me have you reach, reach all the way to the ceiling. OK. That's good. Does that hurt?

Stewart: No.

Dr. Wells: Come all the way down to your side. Hug your body with your elbows and turn out. So this is the test to check your external rotator strength of your rotator cuff. So now, don't let me pull in. I'm winning on the left, so that tells me that maybe your external rotators here are injured. OK. 

So now bring your hand to your stomach. Don’t let ... This tests the subscapularis part of your rotor cuff. Don't let me push your elbow backwards. That's great. How about the other side? That's great. OK.

So now your proximal humerus … Occasionally people in your age group get fractures in the proximal humerus, so we palpate this area. Does that hurt Stewart?

Stewart: Yes.

Dr. Wells: OK. How about over here, does that hurt?

Stewart: No, not really.

Dr. Wells: Excellent. OK. So the last part of the rotator cuff. Thumbs down, don't let me push down. I want to see how strong you are. I'm winning on the left. So that makes me suspicious perhaps of rotator cuff injury because I'm winning on the left; you're not as strong on the left.

Dr. WellsOK. Sit on up. Okay. Last part of the exam, your clavicle, your collar bone. Does that hurt?

Stewart: No.

Dr. Wells: Excellent. OK. Now we're concerned about your rotator cuff. So the next step in your evaluation, possibly a fracture here. The next step is that we need an X-ray of your arm, of your humerus, A/P and lateral of the humerus, and then we possibly need an MRI of your left shoulder to determine whether or not you have either a fracture or rotator cuff injury. Thank you.

Related Centers and Programs: Division of Orthopaedics, Sports Medicine and Performance Center