Shoulder pain Communication introduces self to patient describe what is happening to the patient it tends to patient comfort during

ring the physical exam appropriately drapes patient

Inspection SEADS: swelling, erythema or ecchymosis, atrophy, deformity, skin changes clearly states comparison with contralateral joint

Palpation TEST CAA: tenderness, effusion, swelling, temperature, crepitus, atrophy, asymmetry palpate the sternoclavicular joint palpate the acromioclavicular joint palpate the thoracoscapular articulation palpate the acromion, spine, and body of the scapula palpate the greater tubercle of the humerus and the humeral head palpate the tendon of the long head of the biceps in the groove medial to the greater tuberosity

Range of motion active range of motion o looks for pain and limitation of movement throughout

palpates during active movement and comments on the presence of crepitus raise arms forward straight over the head - flexion extend arms backward - extension lift arms laterally over head - abduction swing arm across the chest adduction put hands behind the head - internal rotation put hands behind the back - external rotation

o o o o o o

passive range of motion o guides the shoulder through the same ROM as above - flexion, extension, abduction, adduction, internal rotation, external rotation

Power repeats above ROM but with the application of an opposing force; muscle power may be graded according to the Oxford scale acknowledges that reduced strength, particularly for abduction (arm across the chest) and external rotation (hand behind the back), is common with acute and chronic injuries of the rotator cuff

Special Tests Yergensons test o Bicepital tendonitis

Painful arc o Subacromial impingement

Apley scratch test o o Internal and external rotation

Empty can test o o Supraspinatus tendonitis

Hawkins test o o Rotator cuff tendonitis

Neers test o Rotator cuff tendons impingement

Cross-arm test o o Acromioclavicular joint disorder

Additional testing o o o X-ray from the group Ultrasound MRI

Diagnosis

defines most likely problem to the examiner and the patient summarizes findings for the patient

Joint assessment above and below shoulder joint Neck o Rules out referred pain by Spurlings sign

Palpates cervical vertebra to elicit cervical root impingement or radiculopathy

Elbow