1. Therapeutic Management of Shoulder

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

3. 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)

4. 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

5. Location of common causes of shoulder pain

6. 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)

7. 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