In an orderly fashion palpate the various bony structures of the shoulder. When palpating potentially painful or damaged structures, always begin with the less painful side. Remember to always consider the reaction of your patient to palpation - be aware of verbal and non-verbal painful reactions.

1. Suprasternal Notch - use the tips of your fingers to palpate the notch formed by the superior border of the manubrium sterni.

Above: Palpation of the Suprasternal Notch. This notch can be reduced in size in patients with arthritis.

2. Sternoclavicular Joints - use the tips of your fingers to palpate these two joints between the manubrium and the proximal end of the clavicle. Palpate this joint on both sides at the same time for comparison.

Above: Palpation of the Sternoclavicular Joint. These joints can become swollen and hot in Inflammatory Arthritis conditions like Rheumatoid Arthritis.

3. Clavicle - move your fingers from proximal to distal along the length of the clavicle feeling for irregularity. Palpate this bone on both sides at the same time to facilitate comparison.

Above: Palpation of the length of the clavicle. Palpate first medially (Top), and move laterally (Bottom). Tenderness to palpation and/or palpable irregularity of the structure suggest fracture.

4. Coracoid Process - this structure is located inferior to the distal end of the clavicle. Use your fingers to palpate both sides at the same time. This may be impossible in larger or more muscular individuals, in which case traction may be applied to the posterior aspect of the shoulder, and one side may be examined at a time. Often, this maneuver will be mildly painful in normal individuals. It therefore serves as an effective yardstick by which to compare the reaction of the patient when you elicit truly painful signs and symptoms by examining the area of primary complaint.

Above: Palpation of the coracoid process. This structure is inferior the the Acromioclavicular joint, and medial to the head of the humerus.

5. Acromioclavicular Joint - palpate this joint between the distal end of the clavicle and the acromion of the scapula on each side at the same time to facilitate comparison.

Above: Palpation of the Acromioclavicular joint. Pain, promenence, or history of shoulder trauma could suggest acromioclavicular joint separation.

6. Greater Tuberosity of Humerus - palpate this structure by pressing firmly though the deltoid muscle over the proximal anterior humerus. This manouver may be uncomfortable for the patient. To solidify in your mind that you are palpating the greater tuberosity, have the patient internally and externally rotate their arm while you are palpating. You'll feel; ridge - trough - ridge. These correspond to; greater tuberosity - intertubercular groove - lesser tuberosity.

Above: Palpation of the greater tuberosity of the humerus. Pain on palpation of the greater tuberosity can indicate rotator cuff pathology.

7. Intertubercular (Bicipital) Groove and Biceps Tendon - Inside the intertubercular groove lies the biceps tendon. Palpate just medially to the greater tuberosity. press firmly and internally and externally rotate the patient's arm. You'll feel the biceps tendon roll underneath your finger. It will feel like a cord embedded in the groove that snaps back and forth as you apply pressure to it.

Above: Palpation of the intertubercular groove and the biceps tendon. This can involve moving your fingers repeatedly medial to lateral and lateral to medial to feel the biceps tendon. This can be a painful procedure, but exquisite pain on one side more than the other can reveal biceps tendinitis.