Shoulder

• Clinical Framework:

  • consider the person
  • why are they here
  • what do they want from the assessment and treatment
  • what is their social context and medical background
  • who are they
  • triage for red flags
  • SIN: severity and irrtaibility
• Clinical Framework:

  • consider the person
  • why theyre here
  • what they want from assessment and treatment
  • their social context and medical background
  • who are they
  • triage for red flags
  • SIN: severity & irritability
  • stage
  • acute
  • subacute
  • recurrent
  • chronic
  • dominant pain mechanism
  • nociceptive
  • nerve involvement
  • with/without conduction issues
  • nociplastic
  • structural diagnosis
  • specific/nonspecific
  • main problems
  • pain - weakness causing pain causing further weakness
  • capacity - loss of ROM
  • functional (prioritise)
  • combination
  • hypotheses
  • prognosis
  • % recovery
  • timescale
  • referral
• Roadmap to follow when diagnosing shoulder problems

  
• Take home message when assessing shoulder conditions:

  • You are treating the person, not just the shoulder
  • Be curious, understand how the shoulder works (visualise the tissues)
  • Consider age
  • Mechanism of onset
  • Referred pain
  • Red flags
  • When to refer onwards - know your limits, refer onwards as needed
• Final Thoughts:

  • shoulder pain is common
  • differential diagnosis is difficult but essential to formulate effective treatment plan
  • exercise therapy is integral to all conditions
  • focus on ROM and strength before function - critical for any upper limb movement
  • regaining ROM is often slow - additional intervention often needed
  • complications are common
• Hypothesis:

  • usually either:
  • stiffness - hypomobility conditions
  • OA
  • frozen shoulder
  • instability - hypermobility conditions
  • dislocation - anterior, posterior or inferior displacement
  • weakness - rotator cuff related shoulder pain conditions