Case 5 – Shoulder Pain

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.


  • 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


  • 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


  • 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