Shoulder Assessment
The Shoulder Joint
The shoulder joint is one of the most complex joints in the human body. When we refer to the shoulder we usually mean the glenohumeral joint, which is formed by the head of the humerus and the glenoid fossa of the scapula. We shouldn’t forget that for proper shoulder function, coordinated movement of several other joints is necessary. These are:
- The sternoclavicular (SC) joint: Clavicle and Sternum
- The acromioclavicular (AC) joint: Acromion and Sternum
- The scapulothoracic joint: Not a true anatomic joint. Depends on the integrity of the abovementioned joints.
Epidemiology (Luime et al. 2004)
The literature describes the incidence of shoulder pain to be between 0,9 – 2,5%. (31-35y: 0,9%; 42-46y: 2,5%; 56-60y: 1,1%; 70-74y: 1,6%)Shoulder pain is very common with a point prevalence of 6,9 to 26% in the general population. The 1-month prevalence for shoulder pain is described at 18,5-31%, 1-year prevalence ranges from 4,7 – 46,7%, with a lifetime prevalence of 6,7-66,7%. This makes shoulder pain the third most common musculoskeletal complaint after low back and neck pain with cuff-related problems as the most common shoulder injury. In general, the prevalence of shoulder pain is higher in women and increases with age.
Course
Shoulder pain generally has an unfavorable prognosis with only 30% of patients recovering after six weeks and 54% after six months (Kuijpers et al. 2006). Van der Windt et al. (1996) report a median duration of complaints of 21 weeks. Luime et al. (2004) report that 50-70% of all patients still have complaints after six months, and 40-50% still experience complaints after one year. The recurrence of shoulder pain was reported to be 20-50%.
Prognostic factors
Verhagen et al. (2014) describe that the following factors are associated with a negative prognosis for recovery:
- High pain score at baseline
- Long duration of complaints
- Insidious onset of complaints
- Concomitant neck pain
- Impairments in activities of daily living (ADLs)
- Psychological factors without further specification
- Repetitive movements are described as a factor in work-related shoulder pain
Red flags
Next to the general red flags, specific red flags in the shoulder joint can be:
Region-specific red flags
- Tumors in the brain, breast, lung (most often Pancoast tumors), liver, and spine
- Infections: History of surgery, open wound, swelling, redness, heat fever
- Avascular necrosis: Trauma, Cancer, steroid use/abuse (Gruson et al. 2009)
Tract anamnesis
In general, all tissues irritating the diaphragm can create visceral referred pain in the shoulder
- Heart disease/angina: Often sharp stabbing pain in the left shoulder, arm, lateral neck, increasing with exercise; risk factors include: Age>40y, hypertension, diabetes, smoker, high cholesterol, etc.
- Respiratory system: Look for impairments in breathing, shortness of breath, dizziness, etc.
- Liver cirrhosis (right shoulder): excessive alcohol, family history of liver disease, history of Hepatitis B or C, obesity, jaundice, swollen legs, ankles, abdomen (ascites), feet
- Spleen (abscess or rupture can produce left ACJ pain): Kehr Sign –> Pain increases in supine with feet elevated (Söyüncü et al. 2012)
- Gall bladder/Cholecystitis (right scapula): Increase in pain after a fatty meal, fever, nausea, vomiting
- Peptic ulcer (deep dull pain felt mid-thoracic/scapula): Increases after meals, long-term use of NSAIDs
Apart from red flags, shoulder pain has to be distinguished from referred pain from the cervical facet joints in the neck, cervical myelopathy, or cervical radicular syndrome. So if concomitant neck pain is present, further examination of the neck region should be done in order to rule out the above-mentioned pathologies. In order to learn more about these differential diagnoses, we would like to refer you to the “Further reading” section at the bottom of this unit.
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Basic Assessment
Shoulder pain can be roughly divided into three main groups:
- Shoulder pain with limited passive range of motion (PROM) and shoulder pain directly related to the glenohumeral joint (Frozen Shoulder or Osteoarthritis)
- Shoulder pain without limited PROM, but a painful abduction component (painful arc), usually indicating Subacromial Pain Syndrome (including rotator cuff pathology with or without tendinopathy of the biceps and bursitis)
- Other shoulder complaints without limited PROM and without a painful arc (Shoulder Instability, AC or SC Joint Pathology)
In order to divide your patient’s shoulder pain into one of those 3 categories, a basic assessment should be performed. It’s best to start with an Active Range of Motion Assessment:
Standard values for the range of motion in different directions are as follows:
As described in the basic categorization above, it is important to look for a painful arc.
AROM assessment is then typically followed by Passive Range of Motion Assessment (PROM) which you can watch by a click on the following video:
During PROM assessment, it’s important to compare the range of motion as well as the end-feel of the affected shoulder with the unaffected side. After AROM and PROM assessment you should be able to categorize the patient into one of the three basic categories for shoulder pain.
Stenvers et al. (1977) have come up with 5 different quick tests in order to assess the mobility of the shoulder girdle.
Specific Pathologies in the Shoulder
There are several pathologies that are commonly seen in the shoulder area. For more information, click on the respective pathology (content will be added in the near future):
- Rotator Cuff Tear
- Full-Thickness Rotator Cuff Tears
- Scapular Dyskinesis
- Subacromial Pain Syndrome
- Internal Shoulder Impingement
- Shoulder Instability
- SLAP (Superior Labrum Tear from Anterior to Posterior) lesion/Biceps Tendinopathy
- Acromioclavicular Joint Pathology
- Frozen Shoulder
References
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What customers have to say about this online course
- Fokke Baarssen13/03/24Orthopedic Physiotherapy of the Upper and Lower Extremities ERGE GOEDE BRUIKBARE CURSUS
Zeker aan te raden. De meest voorkomende pathologiën komen aan bod . opbouw cursus is goed. Zeer overzichtelijk. Zeer gebruiksvriendelijk menu. Zeer goede bruikbare info welke je in de praktijk goed kan gebruiken. Top trouwens dat je altijd de cursus kunt nalezen indien nodigThijs de Jager10/03/24Orthopedic Physiotherapy of the Upper and Lower Extremities GOOD EVIDENCE BASED COURSE!
I would recommend people taking this course if they want to have a good understanding of the current evidence of upper and lower extremity conditions treated by physical therapy.Dominik Meier08/03/24Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE! COMPACT AND CLINICALLY RELEVANT!
This course is compact, clinically relevant, extremely well-researched and carefully structured. I can really recommend it! I like the theory and especially the cases. Thank you! - Bas Polman07/02/24Orthopedic Physiotherapy of the Upper and Lower Extremities ECHT WAUW, PHYSIOTUTORS IS VOOR MIJ EEN GEWELDIGE ONTDEKKING
De cursus is geweldig.
– een goede methodische opbouw voor het leren
– duidelijke toelichting
– video’s
– quizen om je te testen, maar niet te lang en tussentijds
– literatuur
Gewoon ideaal! Voor opfrissen, voor nieuwe dingen leren en gewoon goed.Amy van Ast26/01/24Orthopedic Physiotherapy of the Spine UIGEBREIDDE EN ZEER LEERZAME CURSUS
Erg tevreden over de inhoud van de cursus. Erg leerzame cursus, die ik zeker op latere momenten nog eens zal raadplegen voor opfrissen van informatie. De video’s zijn op een rustige manier opgezet, waardoor het makkelijk te volgen is. (Het aantal accreditatiepunten voor de prijs is ook erg goed. Bij vragen of het aanvragen van accreditatiepunten krijg je zeer snel respons (accreditatepunten binnen 1 dag bijgeschreven).
Een heel klein kritiekpuntje is omtrent de vertaling van het engels naar het nederlands (vooral in de toetsen). Deze klopt niet altijd, waardoor je even moet nadenken wat ze bedoelen (echter ben ik erg slecht in Engels, dus kan mij voorstellen dat niet iedereen daar last van heeft).Christopher Legler25/01/24Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT COURSE
Very pleased. It was thorough and well worth it! - Mathias Smits29/12/23Orthopedic Physiotherapy of the Spine ZEER INTERESSANTE, UITGEBREIDE CURSUS OMTRENT GEHELE WERVELKOLOM
Super gestructureerde, interessante cursus.
Waarbij je een mooi overzicht krijgt over meest voorkomende pathologieën van de rug.
Voordeel is dat je de cursus kan blijven raadplegen doorheen de tijd.
Zeker een aanrader voor kinesisten die veel werken met MSK-populatie!Maria Gerlich01/12/23Orthopedic Physiotherapy of the Spine EXCELLENT COURSE HIGHLY RECOMMENDED
Excellent course: well organized, clearly presented, thorough and clinically relevant.Yara Tuïnk29/11/23Orthopedic Physiotherapy of the Upper and Lower Extremities FIJNE CURSUS
Ik heb deze cursus een half jaar na afstuderen gedaan. Ik vond het een fijne cursus om mijn kennis weer op te frissen en me verder te verdiepen in bepaalde aandoeningen. - Lorcan Hormigo Torres04/09/23Orthopedic Physiotherapy of the Upper and Lower Extremities EXCELLENT COURSE
High quality course, with practical information that can immediately be applied, based on scientific literature up to date. Excellent to summarize the fundamentals of assessment.Josh Hermans23/07/23Orthopedic Physiotherapy of the Upper and Lower Extremities SUPERB COURSE
This course was everything I expected and more! Logical structure, enough depth and clinical reasoning is challenged.Lucinda de Vries20/02/23Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTHERAPY OF THE UPPER AND LOWER EXTREMITIES
Super interessante en leuke cursus. Ook zeker voor afgestudeerde fysiotherapeuten om hun kennis weer op te halen/bij te spijkeren. Ondanks dat ik al 5 jaar werkzaam ben als fysiotherapeut was deze cursus zeker een uitdaging en op veel punten echt heel moeilijk en leerzaam.
Het enige vervelende (waar weinig aan gedaan kan worden). de vertalingen eng-nl zijn soms heel onduidelijk.
Al met al zeer genoten tijdens het volgen van deze cursus en er zullen er zeker meerdere volgen. - Aurelio Basile09/12/22Orthopedic Physiotherapy of the Upper and Lower Extremities ORTHOPEDIC PHYSIOTERAPY OF THE UPPER AND LOWER EXTREMITIES
Great course! It allows you to make objective assessments with order and clarity. As a result, it is possible to set up effective and efficient treatments.
I also found the sections on the epidemiology and course of the diseases very useful, in order to educate patients and obtain greater compliance with the treatment. Super recommended!!Aurelio Basile09/12/22Orthopedic Physiotherapy of the Spine ORTHOPEDIC PHYSIOTERAPY OF THE SPINE
Fantastic course! simple to follow and extremely helpful in assessing and treating spinal related issues. Furthermore, it is possible to immediately apply the knowledge acquired in the clinic. A must for us physiotherapists.DUNCAN10/01/21Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Great course, lots of information, the instruction videos are really helpful. - DOUWE WILLAERT28/12/20Orthopedic Physiotherapy of the Upper and Lower Extremities i would recommend this course to everyone.
if i may give one suggestion that is maybe hard to implement. but i sometimes struggle with explaining things in patient language. so maybe add some frequent asked questions / mechanisms from patients and how to explain it simple or with a metaphore ?
Thanks again for all your work putted in to this course <3JEROEN VAN ZANTEN20/10/20Orthopedic Physiotherapy of the Upper and Lower Extremities I LOVE IT
This course really helps the starting physio. It gives you more convidence. The first year out of school i was really not convident and after this ( relative cheap) course, it got better! Thanks a lot physiotutors! I also got motivation to start studying manual therapy, as i know now, that there is way more to learn.WOUTER13/09/20Orthopedic Physiotherapy of the Upper and Lower Extremities FUN AND EASY TO IMPLEMENT IN THE CLINICAL PRACTISE
Took my time to learn and enjoy form this course!
Would definitely recommend this to other physiotherapist who work in the first-line care. - ANTONIUS SMOOK22/08/20Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
They go, from the basic assessment to the lower and upper limb, step by step with scientific reasoning. It’s a very usefull course to improve your clinical reasoning in practice.JASMIN KONJIC07/07/20Orthopedic Physiotherapy of the Upper and Lower Extremities REALLY REALLY GREAT!
Everything is extremely well-researched and carefully structured! My only complaint, or actually just a hope for their future courses is that more things should to be structured as bullet points. It can sometimes hard to remember facts from a big block of text. Other than that, amazing. Thanks for your great work guys, it’s been a big help!AVIV27/05/20Orthopedic Physiotherapy of the Upper and Lower Extremities Great course, very nice and clean, full attention to details, great job boys!
Cheers,
Aviv - Thomas20/03/20Orthopedic Physiotherapy of the Upper and Lower Extremities STARKES KONZEPT!
Starkes Konzept wissenschaftlich untermauert für die Haupt-Diagnosen der Extremitäten. Sehr übersichtliches Design. Gute Möglichkeit das Lernen einzuteilen. Fortbildung der Zukunft. Nur zu empfehlen. Freue mich auf die nächsten Kurse!Marc07/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities LEERZAAM
Goede opbouw en uitleg per onderdeel.JUDITH06/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities My compliments for this online course! I’m feeling all up to date now! I can see why it is highly accredited with the KNGF. Other than expected I quite enjoyed taking the course! Good structure ,good balance between text en videos and content en quiz. For me the assessment assignments worked great to lock the knowledge in! Quizzes are sufficiantly challenging and force/ motivate to really study the contents, think about it and listen to the questions carefully!
Great video footage of tests and exercises! Great links to articles! All very useful for dailey practice (even in osteopathy ;)) and immediately applicable! Should contribute to communication with other health care specialists e.g. when it comes to clinical reasoning for requesting further medical examination e.g. immaging. I already recommended the course to several colleagues!
One point of attention: I got the feeling that the short quizzes at the end of each unit didn’t always mach the unit’s content or plainly state differently (e.g. Type of SLAP lesions). - AARON03/01/20Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT INFORMATION
Much of it was fresh rehearsal including some new insights! Would recommend.DIMITRY22/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities THE FUTURE OF PHYSIOTHERAPY
I think this course should be done by all physiotherapists! The evidence based principle should be adopted by every physiotherapist, this course is a great way to learn how to apply tests, but also background information, advice for patients and some rehabilitation. I believe this kind of course is the future of physiotherapy and is very suitable for everyone.Marijke13/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities BEDANKT!
Uitstekende manier van leren. - LIEKE11/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities PERFECT
The course was very interesting Learned a lot!JORN08/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities ZEER LEERZAAM!
Zeer leerzame cursus, welke zeker de moeite en tijd waard is!
Gaat goed stapsgewijs dieper in op de stof.
Zorg er wel voor dat je engels up-to-date is.MATAN03/12/19Orthopedic Physiotherapy of the Upper and Lower Extremities GREAT COURSE
Super cursus!! Overzichtelijk en up to date.