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Objective: To describe the history and physical examination of the athlete's shoulder.
Background: The complex, highly mobile shoulder joint is very susceptible to athletic injury. A comprehensive history and physical examination lay the groundwork for accurate decision making about the nature of the injury and the appropriate treatment plan.
Description: In taking the history, inquire about the patient's lifestyle (dominant hand, occupation, sports, activity level) and then focus on the specific complaint. Ask about the location, quality, and nature of the pain and activities that provoke the pain. If stiffness is a factor, a review of systems and the
patient's past medical history are important. Discuss any previously undertaken interventions and their effects. The physical examination consists of inspection, range of motion, palpation, manual muscle testing, and provocative tests.
Clinical Advantages: Once the clinical evaluation has been completed, the nature of the injury will, in most cases, be apparent. If necessary, appropriate diagnostic tests are ordered, and then a treatment plan tailored to the athlete and the injury is instituted.
Key Words: acromioclavicular joint, rotator cuff, throwing athlete, shoulder instability, impingement, glenohumeral ligaments
In order to assess the athlete's shoulder adequately, the evaluator must first understand the basic anatomy of the glenohumeral joint and related structures. Once this foundation is in place, skill in clinical examination can be refined. The shoulder is the most mobile joint in the human body, the result of complex anatomical and biomechanical relationships. However, this complexity also makes shoulder problems among the most commonly encountered complaints presented to physicians, therapists, and athletic trainers.
Common complaints about the shoulder can include any combination of pain, instability, and stiffness. The etiology of these symptoms covers a broad range of diagnoses. A comprehensive history and physical examination is the cornerstone to accurate decision making regarding the need for diagnostic studies and formulation of an appropriate treatment plan.
HISTORY
A thorough history begins with the clinical evaluation of the shoulder; it can often narrow the differential diagnosis and serves to guide the physical examination. Clinical data forms are useful means of recording and organizing data obtained during the initial evaluation.
Before inquiring about the patient's specific complaint, obtain initial information including the patient's age, dominant hand, occupation, sporting activities, and activity level....