The anamnesis is composed by civic information, physical activity or hobbies, occupation, history of the disease as well as the patient’s bio-psychosocial environment.
The various bio-psychosocial factors are important to take into account when managing a patient with chronic pain.
Shoulder Assessment
The different part of the scapular girdle assessment
- Anamnesis
- Type of pain
- Objectives
- Red flags
- Neurological assessment
- Joint assessment
- Muscle assessment
- Visceral assessment
- Synthesis
- Patient follow-up
- Appendices
- Sources
1. Anamnesis
2. The type of pain
Pain is first assessed by determining the part of the sensory and the emotional in the pain intensity.
Then thanks to a body chart adapted to lumbar pathologies, where the patient can himself represent his pain.
Finally, for a good treatment, it is useful to clearly define the type of pain. Pain can be classified into three categories, nociceptive, neuropathic or by central sensitization (see source 1), in particular thanks to the questionnaires of Neuropathic Pain (DN4, here) and of the Central Sensitization Inventory (CSI, here).
3. Treatment goals and objectives
The objectives are defined with the patient in order to know this expectations of the treatments.
They allow us to know how are the expectations of the patient ‘s pain evolution.
They help the patient’s compliance and adherence to the therapeutic plan to achieve the goals developed together.
4. Red Flags
Red flags (see source 2) specific to of the shoulder pain must be identified and the patient refered if necessary.
A summary table helps to check that the patient does not have infection, fracture, tumor, vascular, neurological or inflammatory pathology
5. Neurological assessment
If nervous tissue damage is suspected, an assessment of sensitive and motor deficits is done to start the neurological examination.
Osteo-tendon reflexes are tested to determine if there is central or peripheral nervous system damage.
In peripheral involvement, a local examination of the shoulder is performed to detect pain in the suprascapular nerve (supraspinatus and infraspinatus atrophy), the long thoracic nerve (scapula alata), or the axilary nerve (shoulder hypoaesthesia). If necessary, the cervical spine can be inspected (see cervical assessment).
6. Joint assessment
A subacromial conflict is demonstrated by the combination of 5 specific diagnostic tests:
- Neer
- Hawkins
- Jobe
- Isometric external rotation
- The painful amplitude of 60 to 120 ° of abduction of the arm (see source 3).
Lesions of the glenoid bulge are explored by the compression-rotation test, the crank test and the jerk test (see source 4,5,6).
The acromioclavicular joint is tested using the cluster: active compression test, Paxinos sign, and Hawkins test (see source 8).
Ligamentary and capsular instabilities are explored by the shift and load test, and the apprehension and refocusing test (see source 9,10).
The scapulo-humeral kinetics are evaluated in case of suspicion of dyskinesias.
An internal shoulder conflict often associated with a GIRD lesion is sought in sportsmen with pain who practice a throwing sport.
GIRD Lesion
8. The visceral assessment
Can be performed in case of suspected pain referred or projected of visceral origin.
9. The Synthesis
The summary makes it possible to highlight the essential points of the assessment and to avoid confusion in the face of all the information provided by the patient.
10.Patient follow-up
A part is dedicated to patient follow-up in order to note the changes session after session as well as the advice and exercises to be performed.
11. Appendices
The complete appendices and details each section of the assessment with a description of the clinical signs, the reference values of the tests, with summary tables and diagrams.
In case of doubt, a quick glance at the appendices will provide the answer to your question.
Sources
- John Borstad, Christopher Woeste. The role of sensitization in musculoskeletal shoulder pain. Braz J Phys Ther. 2015 Jul-Aug; 19(4): 251–256.
- Artus M, Holt TA, Rees J. The painful shoulder: an update on assessment, treatment, and referral. Br J Gen Pract. 2014;64(626):593–595.
- Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.
- Gismervik SØ, Drogset JO, Granviken F et al. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord. 2017 Jan 25;18(1):41.
- Hanchard NCA, Lenza M, Handoll HHG, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database of Systematic Reviews 2013, Issue 4.
- Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012 Nov;46(14):964-78.
- Silva L, Andréu JL, Muñoz P et all. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford). 2008 May;47(5):679-83.
- Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. Phys Sportsmed. 2018 Feb;46(1):98-104.
- Tzannes A, Paxinos A, Callanan M, Murrell GA. An assessment of the interexaminer reliability of tests for shoulder instability. J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):18-23.
- Aerni G, Tirabassi J. Shoulder Conditions: Traumatic Instability and Laxity. FP Essent. 2020 Apr;491:22-26.
- Taylor SA, Newman AM, Dawson C, et all. The “3-Pack” Examination Is Critical for Comprehensive Evaluation of the Biceps-Labrum Complex and the Bicipital Tunnel: A Prospective Study. Arthroscopy. 2017 Jan; 33(1):28-38.
