Shoulder Assessment

Sports med 2

HistoryA“Type of pain” pins and needles = radiating pain from cervical

pathology sharp pain = acute inflammation dull, aching, sense of heaviness = chronic

rotator cuff deep, aching pain in the neck/shoulder region =

thoracic outlet compression syndrome (TOCS) night pain = rotator cuff tear burning pain = acute tendinitis weakness, numbness =

nerve pathology

History

B“specific movements that cause pain” neck = cervical spine injury shoulder ER = dislocation/subluxation above 90 degrees = ACJ

History Normal activities Ability to talk/swallow = SCJ Which hand is dominant shoulder often lower differing ROM differing strength

Observation

From all sides symmetry

• level of shoulders muscle wasting v. hypertrophy deformities discoloration swelling how the shoulder is carried

Observation

Anteriorly Step deformity at the ACJ =

dislocation Flat deltoid = anterior dislocation

Observation

Laterally kyphosis: shoulders slumped

forwards

Observation

Posteriorly muscle definition scapulohumeral rhythm scapular winging during flexion and

abduction

PalpationAnterior structures clavicle sternoclavicular joint sternocleidomastoid

muscle acromioclavicular

joint trapezius deltoid coracoid process sternum ribs and costal

cartilage

humerus and rotator cuff muscle

with thumb on subscapularis, second, third and fourth fingers will be over the insertion of other three rotator cuff muscles: supraspinatus, infraspinatus, teres minor

axilla posterior wall = lats anterior wall = pec major medial wall = serratus

anterior

Palpation

Posterior structures scapula spine of scapula medial border of the scapula inferior angle lateral border supraspinatus and

infraspinatus muscles

AROM abduction note painful arc (45 – 60 – 100 degrees) observe scapulohumeral rhythm first 30 degrees no net movement of the scapula setting 30-90 degress scapula abducts and upwardly rotates 1

degree for each 2 degree of humeral elevation 90 – 180 degrees scapula moves 1 degree for each 1

degree of humeral elevation observe any apprehension flexion ER IR Extension Adduction Horizontal adduction/abduction Circumduction Appley’s scratch test

Sort of!

Apley’s ScratchName Purpose Description

Apley’s Scratch Test

Tests for limitations in motions of the upper extremity. Each motion is performed bilaterally to compare.

Action 1: The subject is instructed to touch the opposite shoulder with his/her hand. This motion checks Glenohumeral adduction, internal rotation, horizontal adduction and scapular protraction.Action 2: The subject is instructed to place his/her arm overhead and reach behind the neck to touch his/her upper back. This motion checks Glenohumeral abduction, external rotation and scapular upward rotation and elevation.Action 3: The subject puts his/her hand on the lower back and reaches upward as far as possible. This motion checks glenohumeral adduction, internal rotation and scapular retraction with downward rotation