Shoulder Evaluation Module

Bony Anatomy

Subjective/ History

Determine ⁶: activity, MOI, location of pain, type of pain, severity of pain, onset of pain, unusual sounds/ sensations, actions that increase & decrease pain, S/S, change in S/S over time, prior injury/ surgery, family history & general medical health

Objective

Inspection ^1,6:

General: swelling, discoloration, deformity, muscle symmetry/atrophy, symmetry of head and arm while standing & walking

Skin: discoloration, open wounds, scars & skin infections

Anterior View: level of shoulders, contour of clavicles, deltoid muscle group, anterior humerus & biceps brachii

Lateral View: deltoid muscle group, acromion process, position of humerus & spinal vertebrae alignment

Posterior View: alignment of spinal vertebrae, position of scapula, muscle tone & position of humerus

Shoulder Palpation Rollover: using internet explorer rollover the images to trace some anatomy of the shoulder

Bony Palpation ¹: Suprasternal Notch, SC Joint, Clavicle, Coracoid Process, AC Joint, Acromion, Lesser Tuberosity of the Humerus/Bicipital Groove/Greater Tuberosity of Humerus, Spine of Scapula, Vertebral/Medial Border of Scapula, Inferior Angle of the Scapula, Superior Angle of the Scapula

Soft Tissue Palpation ¹:

Zone 1 (Rotator Cuff ): supraspinatus, infraspinatus & teres minor

Zone 2 (Subacromial/ Subdeltoid Bursa): subacrominal/ subdeltoid bursa

Zone 3 (Axilla): pectoralis major (anterior wall), latissimus dorsi (posterior wall), ribs 2–6 and serratus anterior muscle (medial wall), bicipital groove of humerus (laterall wall), axillary lymph nodes, brachial plexus, axillary artery

Zone 4 (Prominent Muscles of the Shoulder Girdle): sternocleidomastoid, pectoralis major, biceps, deltoid, trapezius, rhomboid (minor/major), latissimus dorsi, serratus anterior

Range of Motion ^1,5:

AROM: abduction, adduction, extension, flexion, internal rotation & external rotation

PROM: abduction (0–180°), adduction (0°), extension (0–60°), flexion (0–180°), internal rotation (0–70°) & external rotation (0–90°)

RROM: abduction, adduction, extension, flexion, internal rotation & external rotation

Manual Muscle Testing  ²:

Biceps Brachii, Brachialis, Coracobrachialis, Triceps Brachii, Anconeus, Supraspinatus, Middle Deltiod, Anterior Deltiod, Posterior Deltoid, Teres Major, Pectoralis Major (Upper/Clavicular), Pectoralis Major (Lower/Sternal), Pectoralis Minor, Latissimus Dorsi, Subscapularis, Infraspinatus, Teres Minor, Rhomboids, Rhomboides (Alternate), Levator Scapulae, Trapezius (Upper), Trapezius (Middle), Trapezius (Lower), Serratus Anterior

Special Tests  ^3,7:

Acromioclavicular Joint Compression (Shear), Sternoclavicular (SC)/Acromioclavicular (AC) Joint Stress, Empty Can, Yergason, Speed's, Ludington's, Drop Arm, Hawkins–Kennedy Impingement, Piano Key Sign, Anterior Apprehension, Posterior Apprehension, Sulcus Sign/Long Arm Traction/Inferior Apprehension, Anterior Drawer, Posterior Drawer, Jobe Relocation, Grind, Clunk, Active Compression, Adson's Maneuver, Allen's, Provactive Elevation, Military Brace Position, Pectoralis Major Contracture, Cross–Over Impingement, Railroad Whistle, Swim Stroke, Jerk, Neer Impingement

Assessment

Identifies examiner's impression of injury & potientally complicating factors based on subjective & objective information

Plan

Explains examiner's goals as well as how the examiner intends on meeting these goals through initial management, treatment, rehabilitation