Common causes of shoulder pain:
- Rotator cuff pathology
- Adhesive capsulitis
- AC joint disease
- Referred pain
Top 3 History Questions:
- Was there an injury/trauma?
- Are you losing strength?
- Are you losing ROM?
- Visualization (look for skin changes, bony abnormalities, asymmetries, muscle bulk/atrophy)
- Palpation (start with the cervical spine, then each bone, joint, and muscle belly/tendon insertion)
- Active and passive ROM
- Provocative testing
- Curious how to perform a telemedicine exam of the shoulder? Check out this article by the Mayo Clinic!
- Pain all of the time
- Real trauma in younger patients, without real trauma in older patients
- Drop test, empty can test, lift off or bear hug, resisted external rotation
Consider MRI if you are concerned for an acute rotator cuff tear!
- Pain at night, especially with sleeping on that side
- Pain with ROM especially flexion >90º
- Usually no weakness, can do ADLs
- Neer’s test, Hawkin’s test, painful arc 60-120º
- Point precisely to AC joint as site of pain
- Cross arm test, painful arc >120º
- Pain all the time
- Loss of ROM (can start with pain with ROM)
- No real trauma
- Associated with diabetes
- Differentiate from OA with XR
- Limited ROM in capsular pattern (external rotation > abduction > internal rotation)
The Boyd Test*
- Çalış, Mustafa, et al. “Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome.” Annals of the rheumatic diseases 59.1 (2000): 4447.
- Hegedus, Eric J., et al. “Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests.” British journal of sports medicine 42.2 (2008): 80-92.
- Hermans, Job, et al. “Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review.” JAMA 310.8 (2013): 837-847.
- Jain, Nitin B., et al. “The diagnostic accuracy of special tests for rotator cuff tear: the ROW cohort study.” American journal of physical medicine & rehabilitation 96.3 (2017): 176.
Blog post based on Med-Peds Forum talk by Chelsea Boyd, PGY2