History
It is important to determine the exact site of the patient's pain, although pain is often poorly localized. The onset of shoulder pain may be either acute, for example, a dislocation, subluxation or rotator cuff tear, or insidious, such as rotator cuff tendinopathy.
The position of the shoulder at the time of an acute injury provides useful information. If the arm was wrenched backwards while in a vulnerable position it suggests anterior dislocation or subluxation. The history of a fall onto the point of the shoulder can cause acromioclavicular joint injury. In chronic shoulder pain, the activity or position that precipitates the patient's pain should be noted, such as the cocking phase of throwing or the pull-through phase of swimming.
It is important to note the severity of the pain and the effect of the pain on activities of daily living and sporting activity. If tendinopathy is present, the severity may be graded by the relationship of the pain to activity. Although night pain is a common symptom in complete tear of the rotator cuff, serious pathology such as malignancy should be excluded.
Shoulder pain may radiate proximally into the neck, the upper arm or, less commonly, the forearm, wrist and hand. The activities that aggravate and relieve pain, should also be noted, and in particular, the position of the shoulder than relieves the pain or symptoms is of great clinical assistance.
Sensory symptoms such as numbness or pins and needles should be noted as should any muscle weakness in the upper limb. Any episodes of 'dead arm' are significant.
To assess whether there are any deficiencies in the kinetic chain the clinician should enquire as to past or present spinal or lower limb problems. Attempts should be made to determine the existence of any predisposing factors. A training diary may indicate excessive load on the structures around the shoulders.
|
