Evaluation of the Shoulder

Shoulder Injury Evaluation Overview

Anatomy History Observation Palpation Neurological exam Circulatory exam

Shoulder Anatomy

Clavicle Scapula Humerus Articulations:

◦ Sternoclavicular joint◦ Acromioclavicular

joint◦ Glenohumeral joint

Shoulder Anatomy Ligaments

◦ AC ◦ Glenohumeral

ligaments/joint capsule

Labrum

Shoulder Anatomy

Musculature◦ “Rotator cuff”

Subscapularis Supraspinatus Infraspinatus Teres Minor

Shoulder Anatomy Musculature

◦ Pectoralis major◦ Deltoid◦ Trapezius

Shoulder Anatomy Subacromial bursa

History

Mechanism of injury:1. Describe the mechanism of injury2. Was there a direct blow? 3. What was the angle of impact? 4. What was the position of the arm at impact?5. Did you hear or feel anything at the time of

injury?6. Was the arm forced beyond normal limits? 7. Did the injury occur due to forced muscular

contractions?

History

Pain/Symptoms:8. Demonstrate what movements aggravate pain? 9. What activities increase pain? 10. Describe the onset of symptoms11. Describe symptoms? 12. Sharp or dull? 13. Constant or intermittent? 14. Localized or diffuse? 15. Aggravated by movement?16. Relieved by rest?

History

Pain/Symptoms (cont.):17. Where is the pain? 18. Do you feel pain radiating down the arm? 19. Is there any numbness, burning, tingling or

weakness in the upper extremity? 20. Do you feel tightness, tension, locking, swelling,

or crepitation?

History

Previous injuries:21. Have you had a previous injury? 22. Are the symptoms you are experiencing

currently similar to those associated with the previous injury (‘Your’ pain)?

23. What treatment was used? 24. What rehabilitation was used? 25. Were you fully recovered?

Observation

1. Swelling2. Skin color3. Signs of trauma4. Skin temperature5. Sprengel’s deformity6. Atrophy7. Abnormal position

Observation

1. Swelling2. Skin color3. Signs of trauma4. Skin temperature5. Sprengel’s deformity6. Atrophy7. Abnormal position

Observation

8. Arm hanging limp9. Appear to be in pain 10. Compare 11. Symmetry 12. Deformities 13. Muscle spasm14. Holding or supporting arm 15. Moving or using involved extremity 16. Overall position, posture, and alignment

Palpation: Bone

1. Acromion process 2. Clavicle 3. Acromio-Clavicular (AC) joint 4. Sterno-Clavicular (SC) joint 5. Coraco-Clavicular (CC) joint 6. Coracoid process 7. Axilla

Palpation: Bone

8. Head of humerus 9. Greater tuberosity 10. Lesser tuberosity 11. Bicepital groove 12. Deltoid tuberosity 13. Humerus 14. Scapula

Neurologic Exam: Sensory Sensory dermatomes

C2-C3: Occipital area and angle of jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect of

shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and index

finger C7: Middle finger and palmar aspect of

hand C8: Small finger, ring finger, and medial

portion of palmar surface T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm

Neurologic Exam: Motor C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external

rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation T1: Finger approximation

Neurologic Exam: Reflexes Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8)

DTR: Biceps (C5-C6)

DTR: Supinator/Brachioradialis (C5-C6)

DTR: Triceps (C7-C8)

Circulatory

Carotid Brachial Radial

Muscular anatomy Special tests

To Be Continued…