Shoulder Observation & Active ROM

• Shoulder - Observation:

  • need to do informal and formal observations:
  • posture types and variations
  • muscle tone and bulk - difference between left and right?
  • soft tissue
  • pts attitude and behaviour (happy, sad, fearful, pain)
• Shoulder - Observation:

  • anterior view:
  • shoulder height symmetry
  • continuity of clavicle
  • prominence of the acromioclavicular joint and sternoclavicular joint
  • muscle bulk changes
• Shoulder - Observation:

  • lateral view:
  • position of head in relation to the trunk
  • spinal curves - any excessive kyphosis?
  • shoulder girdle - protracted or retracted?
  • humeral head position - anterior, posterior or inferior displacement?
• Shoulder - Observation:

  • posterior view:
  • shoulder girdle/scapular position - elevation, winging, rotation, protraction
  • muscle bulk changes - rotator cuff, trapezius, deltoid
  • spinal symmetry
• Shoulder

  • Clear the neck as neck pain can refer to the shoulder and resemble shoulder pain symptoms:
  • before shoulder movement
  • in neck pain - repeated movements (of flexion/extension and side flexion) more likely to reproduce symptoms than single movement
• Shoulder - Functional Tests:

  • ask pts to show a relevant functional movement
  • can also choose compound movement such as hand behind head for a quick screen of multiple structures
  • can act as marker for improvement and help plan assessment
  • can also help modify technique of pts functional movements to reduce aggravating positions
• Shoulder - Palpation:

  • useful in telling us if certain structures reproduce pain
  • can tell us if muscles are overactive, resulting in a muscle spasm, which is a protective response
  • can tell us if theres reduced muscle bulk on one side compared to the other
  • can tell us if bony landmarks reproduce pain
• Shoulder - Palpation:

  • sternoclavicular joint - find medial end of clavicle
  • acromioclavicular joint - follow clavicle laterally and superiorly until a small ridge is found
  • coracoid - bony prominence inferior to the acromioclavicular joint
  • bicipital groove - lateral from the coracoid, anterior to humeral head, can move shoulder into lateral and medial rotation to feel dip
  • supraspinatus tendon - shoulder into internal rotation, hand behind back, find acromion and drop into space between acromion and humeral head
  • infraspinatus tendon - arm across chest, palpate posterior aspect of shoulder
• Shoulder - Active Movements:

  • principles of technique:
  • describe movement you want them to perform
  • check resting symptoms
  • ask to stop where they first feel pain or discomfort
  • check location/areas and which discomfort and if it relates to why they've come to see you, measure it using VAS
  • can they move further?
  • ask what is stopping them from moving further - pain discomfort, stiffness
  • monitor symptoms on return
• Shoulder - Active Movements:

  • observe/ask
  • location and range of pain
  • quality of movement
  • compensatory strategies
  • what limits further movement
  • consider best position for pts
  • add overpressure, repetition and speed if required
  • movements:
  • elevation/depression
  • protraction/retraction
  • flexion/extension
  • abduction/adduction
  • internal rotation/external rotation
  • horizontal flexion/horizontal extension
• Shoulder - Active Movements:

  • observe scapula movement:
  • should be able to observe:
  • upward rotation
  • posterior tilt
  • external rotation - with no winging
• Shoulder - Active Movements:

  • modifications:
  • if pain is reported, which modifications helps?
  • e.g. manual facilitation, load changes, postural changes
  • this can help guide further assessment and exercise prescription