Clinical Assessments for Shoulder Problems

Key Points

• Accurate evaluation should be performed by physicians in a lab.
• Therapists (PTs and OTs) use provocative tests but do not diagnose.
• If a problem is suspected, refer back to physicians for confirmation.

Pre-Assessment Considerations

• Understand the Client:
  • How they perform tasks.
  • How they were injured.
  • Diagnosis received.
  • Concerns from referral physicians or surgeons.
  • Verify the accuracy of documented information.

Observational Assessment

• Initial Observation:

  • Observe client from the moment they enter the clinic.
  • Note any support of arms, differences in appearance, signs during evaluation, wounds, etc.
  • Use senses to evaluate wounds (smell, color) and pain.

• Palpation:

  • Assess swelling (edema vs. lymphedema) and circulation.
  • Determine if the problem is muscular or related to tissue.

Occupational Performance Evaluation

• Focus on how clients perform valued occupations.
• Use standardized evaluations to maintain objectivity.
• Common Tools:
  • ADL Observation: Analyze how clients perform Activities of Daily Living (ADLs).
  • AMPS (Assessment of Motor and Process Skills): Trained therapists use criteria to objectively evaluate ADL performance.
  • Canadian Occupational Performance Measure (COPM): Semi-structured interview to evaluate self-perceived satisfaction and performance on selected occupations.
  • Functional Independence Measure (FIM): Basic ADL performance rated on a 7-level scale based on assistance needed.
  • Disability of Arm, Shoulder, and Hand Questionnaire (DASH): Screening tool to identify issues in shoulder, arm, hand, or wrist.

Top-Down Approach to Evaluation

• Evaluate overall occupational performance first.
• Gradually narrow down to identify personal, environmental, or task-related issues.
• Focus on the specific system contributing to the problem.

Conclusion

• Use critical reasoning to identify the contributing factors to the client’s issues.