1. The Shoulder & Pectoral Girdle (1)

2. Symptoms: The commonest symptom is pain Pain in the shoulder region might be a referred pain from the neck Pain from the shoulder joint and the rotator cuff is felt over the front and outer aspect of the joint

3. Symptoms: When the arm is at the “window cleaning” position and there is pain, it is a characteristic of rotator cuff impingement Pain that comes suddenly when the arm is held over head suggests instability Referred pain such as cardiac ischemia can present aching in either shoulder

4. Symptoms: The commonest symptom is pain Pain in the shoulder region might be a referred pain from the neck Pain from the shoulder joint and the rotator cuff is felt over the front and outer aspect of the joint

5. Symptoms: Stiffness may be progressive and severe (frozen shoulder) Swelling might happen in the joint, muscle or bone Deformity may consist of muscle wasting, prominence of the acromioclavicular joint, winging of the scapula, or abnormal position of the arm

6. Symptoms: Instability symptoms include a click or a jerk when the arm is held over head Weakness appears as a true loss of power or as a sudden inability to abduct the shoulder Loss of Function is expressed as difficulty with dressing, or inability to lift objects or work with the arm above shoulder height

7. Signs: look at: Skin: scars or sinuses should be noted + the axilla Shape: compare the 2 sides of the shoulders, winging, wasting of deltoid, supraspinatus, and infraspinatus, and acromioclavicular dislocation (from behind)

8. Signs: look at: Swelling of acromioclavicular or sternoclavicular joints + wasting of pectoral muscles Joint effusion causes swelling anteriorly Wasting of deltoid  nerve lesion Wasting of supraspinatus  1- full-thickness tear 2- suprascapular nerve lesion A bulge in biceps when elbow is flexed  rupture

9. Signs: Feel Bony points and soft tissues: Crepitus over the supraspinatus tendon during movement suggests tendinitis or a tear

10. Signs: Move To test serratus anterior ask the patient to push against the wall