Evaluating Potential Shoulder Problems

Initial Observations

• Observe client's movement when they walk into the clinic
  • Any compensatory movement to avoid pain?
• Consider client's age and daily routine
  • Example: rotator cuff injuries are common in individuals over 50
  • Younger adults with rotator cuff symptoms may indicate a different mechanism of injury
  • Younger individuals may heal faster but tend not to follow protocols
• Daily routine insights can show if the problem is chronic

Screening and Pain Types

• Cervical screening to rule out neck-related issues
• Types of pain:
  • Muscle weakness pain: occurs when using the muscle
  • Nerve pain: includes numbness, tingling, shooting pain

Provocative Tests

• Tests to provoke symptoms and identify specific problems
• Arc of Pain (Painful Arc) Test
  • Client abducts or flexes arm
  • Pain typically occurs between 60° and 120° of shoulder motion
  • Usually indicates rotator cuff or bursitis issues

Resistance Testing

• Differentiates from manual muscle tests
• Isometric contraction to induce pain
• Response to resistance informs about the muscle condition
  • Strong and no pain: normal
  • Strong but painful: possible tendonitis
  • Weak and painful: moderate to high irritation, refer to physician
  • Weak and no pain: possibly chronic or nerve injury
  • Painful in all movements: acute inflammation, avoid further irritation

Specific Tests

Speed's Test

• Evaluates the biceps
• Position: shoulder flexion, palm up, resistance applied to forearm
• Indicates biceps problems if pain is provoked

Rotator Cuff Manual Resistive Tests

• External Rotation Resistance: Tests infraspinatus and teres minor
• Internal Rotation Resistance: Tests subscapularis and pec minor
• Positions vary for different muscle tests
• Pain on resistance: indicates muscle problem

Drop Arm Test

• Arm in abduction and internal rotation
• Client holds position then lowers arm slowly
• Failure to hold or lower arm: indicates supraspinatus problem

External Rotation Lag Sign

• Elbow at 90°, shoulder at 20° abduction
• Arm externally rotated and client asked to hold
• Moving to internal rotation indicates infraspinatus and teres minor issues

Internal Rotation Sign Test

• Arm placed behind the back and lifted off
• Holding difficulty indicates subscapularis issues