Therapeutic Management of Shoulder

Management VS Treatment SOAP stands for? Subjective Examination Objective Examination Assessment Plan of Care Three key points of orthopaedic assessment: Look-feel-move

Subjective Examination Presenting complaints History Of Presenting Complaints ( Mechanism Of Injury) Impairments and Functional Limitations Onset of pain Provocative and relieving activities Location of pain Radiation of pain Referred pain Cervical spine – spondylolysis, arthritis, disc disease Cardiac - myocardial ischemia Diaphragmatic irritation Thoracic outlet syndrome Gallbladder disease Complex regional pain syndrome (a.k.a, reflex sympathetic dystrophy)

Objective Examination (look, feel, move) Inspection Posture Alignment Any swelling, bruising, inflammation ROM passive , active and resisted Reflexes Myotomes ,dermatomes Palpation ; Start medially at the SC joint, proceed laterally, end posteriorly Investigations ( X-RAY ,MRI) Special tests

Location of common causes of shoulder pain

Special Tests Tests for instability Tests for Rotator cuff Anterior instability test/Apprehension test Posterior instability Test / Apprehension test Tests fro specific Muscles Bicep- Flexion Jam/Speed’s test/Yergason’s Test Infraspinatus – Swing door test/ Horn blower’s sign Supraspinatus – Flexion jam test Supraspinatus test Subscapularis – lift off test Serratus Anterior – wall push up Tests for Rotator cuff Neer’s test Salute test Drop Arm test Tests for TOS Adson’s test ( Scalenus anterior) Allen’s Maneuver ( Scalenus medius) Wright’s hyperabduction test ( subcalavian artery)

Develop SOAP for this Case A 45-year-old man presents with a complaint of right shoulder pain. The pain has been episodic for at least 10 years, but has become more severe, constant, and limiting in activities of daily living (ADL) over the past 3 months. There has been no recent trauma to the upper extremity, but the patient had fallen onto the right shoulder skiing 25 years ago. At that time, he had limited use of his right dominant arm for 4 weeks. Eventually, he recovered “full” use of that limb and has participated in regular athletic activities. Three months ago, the patient had been traveling extensively on business. He developed pain in the superior shoulder and lateral aspect of the arm. It is not aggravated by movement of the head and neck, and is not associated with “pins and needles” or “electric shock” sensations in any part of the upper extremity. He has noticed that there is often a sensation or sound of “rubbing” and “popping” in the area of the shoulder when reaching overhead. On physical exam, the patient lacks the terminal 20 degrees of shoulder external rotation due to pain. He shows full strength and no evidence of shoulder instability. His right acromioclavicular joint is larger and more tender as compared with that on the opposite side. There are no neurological deficits found and he has a negative cervical spine exam. X-rays show normal glenohumeral alignment; there is hypertrophy of the acromioclavicular joint with elevation of the clavicle. There is slight sclerosis on the superior margin of the greater tuberosity and minimal narrowing of the subacromial space. This paradigm is most consistent with chronic subacromial impingement because of: A history of prior injury with apparent full recovery Delayed onset of symptoms A history of recent aggravating event(s) Crepitus on ROM without instability