Diagnose yourself: Pain in Shoulder: Examination of the Shoulder

Several diseases can affect the shoulder joint and these diseases can present with various signs and symptoms. 

DISEASES AFFECTING THE SHOULDER JOINT

Pain is one such symptom. It could be of two types.

·         Pain arising within the shoulder joint – this type of pain is felt anterolaterally

·         Referred pain

If you have pain in your shoulder, follow the following 3 steps to diagnose what it is.

1.      Look

2.      Feel

3.      Move

Look

Look at your shoulder carefully to detect following.

1.      Look at the Skin – Look at the skin for scars, bruises, wounds. Even a bruise can be indicative of an underlying fracture of the bone.
2. Compare the painful shoulder with the other one. Does it appears smaller/flatter than the other? This is due to wasting of the deltoid muscle. This muscle gets wasted when the nerve supplying it is damaged. That nerve is the axillary nerve and it commonly gets damaged in anterior shoulder dislocation

SHOULDER DISLOCATION? IS THE AXILLAY NERVE DAMAGED? SIGNS  OF AXILLARY NERVE DAMAGE

            Rotator cuff injuries also cause wasting of rotator cuff muscles, which would be visible.

3.      Is the normal shoulder contour is lost? Then it might be due to dislocation. If it is anterior shoulder dislocation there will be an anterior bulge and a squared-off shoulder.

FEEL

1.      Is the pain generalized or localized?

a.      Generalized pain – arise from neck or the shoulder joint

b.      Localized pain- from acromioclavicular joint

2.      Check the skin sensation – Is there a loss of sensation over the upper part of the lateral aspect of the arm?  This area is also called regimental badge area. This also indicates axillary nerve damage.
 

Regimental Badge Area

 

MOVE

Movements of the upper arm occur in two points. They are at,

1.      Shoulder joint movements

2.      Scapulothoracic joint movements

If the pain is coming from the shoulder joint itself the patient will be moving the arm from the scapulothoracic joint. Follow the following steps to assess the movements of the shoulder joint.

1.      Start in the neutral position.

                                                              i.      Arms by the sides

                                                            ii.      Elbows extended

                                                          iii.      Palm facing forwards

Neutral Position of the body

2.      Stabilize the scapula

                                                              i.      Place the thumb over coracoids process

                                                            ii.      Place the other fingers of the same hand over the spine of the scapula

3.      Forward flexion

                                                              i.      Keep the elbow extended

                                                            ii.      Raise the hands as to touch the roof

4.      Extension

5.      Abduction (painful arc test)

                                                              i.      Raise the arms sideways as to touch the roof

                                                            ii.      First 60⁰ – glenohumeral

                                                          iii.      Then – glenohumeral and scapulothoracic

                                                           iv.      Last – entirely scapulothoracic

                                                             v.      Impingement syndrome – presence of pain from 60⁰ – 120⁰   It indicates rotator cuff pathology.

                                                           vi.      Jobe’s test is also used to identify impingement syndrome.

6.      Adduction

                                                              i.      Touch the other shoulder tip

7.      Internal rotation

                                                              i.      Touch the back with the dorsum of the hand

                                                            ii.      Raise the hand up the back as high as possible

                                                          iii.      A normal person can raise up to 7the thoracic spine level

8.      External rotation

                                                              i.      Bend the elbow to 90⁰

                                                            ii.      Keep the forearm mid prone

                                                          iii.      Now separate the hands

9.      Apprehension test for anterior shoulder instability.

                                                              i.      Flex the elbow to 90⁰

                                                            ii.      Abduct the shoulder to 90⁰

                                                          iii.      Externally rotate the shoulder