Patients Name DOB MRN Date of Visit

Shoulder Pain H & P HPI

KEY: Y = Yes (positive) N = No (negative) NE= Not Examined

History elements to ask:

- Onset of symptoms - Mechanism of injury/ History of trauma or injury - Acute traumatic, overuse, or spontaneous onset - Pop or dislocation with injury - Location of pain - Neck pain - Radiation of pain - Provoking/alleviating factors o - Painful arc (60-120 abduction) - Activities limited

PMH
Prior shoulder injury or instability Prior shoulder surgery Other orthopedic history (surgeries, arthritis, trauma, injuries etc)

--------------------------------------------------------------------------------------------------------------------------------------------------Physical Exam
Inspection Swelling Y N NE Erythema Y N NE Bruising Y N NE Atrophy Y N NE Other deformity:________________________________ ROM (full active/passive) Flexion Abduction Cross Body Adduction External rotation Internal rotation Winging of scapula Scapular dyskinesis Cervical Strength Abduction External Rotation Internal rotation Empty can test (supraspinatus) Lift-off test (subscapularis) Drop Arm Test (supraspinatus) Y Y Y Y Y Y N N N N N N NE NE NE NE NE NE Special Tests Impingement Neers test Hawkins test Biceps Tendinitis Speeds test Labral Tear OBriens Test Crank Test Instability Tests Apprehension test Relocation maneuver Palpation (pain elicited) Sternoclavicular (SC) joint Clavicle Acromioclavicular (AC) joint Greater tuberosity Subacromial Biciptal Groove Neurovascular Sensation Y Y Y Y Y Y Y N N N N N N N NE NE NE NE NE NE NE

Y Y Y Y Y Y Y Y

N N N N N N N N

NE NE NE NE NE NE NE NE

Y Y Y Y Y Y

N N N N N N

NE NE NE NE NE NE

NE

Distal pulses

NE

Assessment (circle suspected diagnosis)

AC joint arthritis AC joint separation Adhesive capsulitis (Frozen shoulder) Biceps tendonitis Biceps tendon rupture Brachial plexopathy Calcific tendonitis/bursitis Clavicular fracture Glenohumeral joint osteoarthritis Greater tuberosity avulsion fracture Multidirectional instability Rheumatoid arthritis Rotator cuff tear Rotator cuff tendonopathy Shoulder dislocation/subluxation Subacromial bursitis Subacromial impingement Other:_____________________________

Plan 1) Treatment (Circle all employed) Rest, activity modification, ice Shoulder Immobilizer/Sling Exercises: (specify)___________________________ Aspiration/Injection:______________________________ 2) Medications NSAIDs Y N Specify:________________________ Other:_____________________________________ 3) Imaging X-rays Y N MRI Y N If yes, specify test ordered:_____________________ 4) Referral Sports Med Y N Orthopedics Y N Physical Therapy Y N 5) Follow up: ______________ Ashwin Rao and Jonathan Drezner, 2007

Figures 1 & 2: Shoulder Anatomy- Figure 1 demonstrates muscular landmarks, including rotator cuff attachments. The supraspinatus inserts most superiorly, followed by the infraspinatus, teres minor, and subscapularis. Figure 2 more clearly identifies the 3 joints of the shoulder (SC, AC, glenohumeral) as well as other bony landmarks

Figure 3- Empty Can Test: Elevate the arms against resistance with elbows extended, the arms abducted and the thumbs pointing downward. Assesses for supraspinatus injury

Figure 4-External Rotation Test: Externally rotate the arms against resistance, while te arms are at the side and the elbows are flexed to 90 degrees. Assesses for teres minor and infraspinatus injury.

Figure 5- Lift Off Test: Place 1 hand behind the back and push out against resistance. Assesses for subscapularis injury.

Figure 6- Neers Impingment Test: Fully Pronate the arm and then flex at the shoulder against resistance. Asesseses test for impingement of the rotator cuff tendons under the coracoacromial arch.

Figure 7 -Hawkins Test: Elevate shoulder to 90o, while keeping elbow flexed at 90 o. Support the arm and then internally rotate the humerus. Pain with this maneuver suggests subacromial impingement of rotator cuff injury.

Figure 8-Cross-Body Adduction: Adduct arm passively across body. Pain at AC joint indicates injury or arthritis.

Figure 9- Speeds Test: Flex the elbow against resistance. Pain indicates biceps tendonitis or injury

Figure 10-Crank Test: Abduct shoulder to 90 o and slowly internally rotate while a gentle axial load is applied to the glenohumeral joint. Pain, catching, or grinding in the shoulder indicates a labral tear (SLAP lesion).

Figure 11- Apprehension Test: Abduct shoulder to while the arm is externally rotated with concominant anterior pressure to the humerus. A sense of instability with this maneuver suggests anterior instability due to a labral tear.