You are seeing Mrs. Kossopoulos, a 26 year old woman, for shoulder pain that has steadily worsening over the last few weeks , during which time she’s been playing softball. Take a focused history and perform a physical exam.
History
- Onset and duration of pain (began during softball)
- Progression
- Alleviating and aggravating factors (worse when bring arm above the shoulders)
- Quality and location of pain
- Radiation
- Presence of night time or morning symptoms (worsens at night)
- Sensory symptoms in the affected arm e.g. numbness, tingling
- Motor symptoms in affected arm e.g. weakness, decreased grip strength
- Associated stiffness
- Fever and other systemic symptoms
- Personal history of arthritis
- Associated trauma/overuse
- Past shoulder pain
- Pain in other joints
- Occupational history as it relates to the pain
- Family history of arthritis
- Effect on daily activities
Physical Examination
Inspection
- Examines both shoulders for SEADS
- Assesses all active ranges of motion of shoulder
- Examines the neck for range of motion
- States that the elbow should be examined as well
Palpation
- Palpates shoulder for crepitus, warmth, and effusion
- Palpates the sternoclavicular, acromioclavicular, and glenohumeral joints for tenderness/deformity
- Palpates all bony aspects of the shoulder joint
- Tests passive range of motion for affected shoulder
Special Tests
- Assesses for rotator cuff pathology
- Assesses for impingement of muscle tendons
- Assesses for shoulder instability
Case 5 – Shoulder Pain