Anterior Shoulder Pain: What Questions Would You Ask in The Subjective Examination?
Anterior Shoulder Pain: What Questions Would You Ask in The Subjective Examination?
Anterior Shoulder Pain: What Questions Would You Ask in The Subjective Examination?
1. Exact area of pain - is it at the tip of the shoulder, or referring over the deltoid? - referral to/from
other areas
3. Constant / intermittent (if constant but varying or intermittent aggravating and relieving factors)
4. Deep/superficial?
5. 24 - Hour picture
7. Functional limitations
9. Previous History
(a) BOS
The pain is constant deep ache, localized to the anterior right shoulder. The intensity
is described as 3/10. There is no neck pain or referred pain, numbness, or pins and
needles into the arm. There is occasional clicking. There is a feeling of heaviness in
the arm (a “dead arm” feeling) and there is sometimes a feeling of instability. The
pain is aggravated by activities that require the patient to reach behind him, such as
putting on his seatbelt, and pulling the sheet over him in bed. This elicits a sharp
pain (7/10) but it settles quickly to resting level. Overhead activities are also painful.
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(b) 24 Hour picture 654
AM: when the patient wakes, the shoulder feels stiff and sore but eases within a ½ hour
with some gentle movement and a hot shower
AM-PM: depends on activity but gradually worse by the end of the day
PM: has some difficulty getting to sleep and wakes during the night if he rolls onto the
right shoulder. It eases quickly if he changes position.
Some dressing activities such as putting on a shirt are painful, and he has ceased his
weight lifting and tennis playing.
(c) CHx - this patient had been doing a gym programme four sessions per week for
about one month and over the previous three sessions he increased his weights
significantly. He had not had a trainer check his technique. The session before last he
started to notice some pain after training but it settled within 24 hours. After the last
session three days ago, he woke the following morning with a constant ache in the right
shoulder that has not subsided.
PHx - the patient had a similar episode of shoulder pain when doing a weight-training
programme at school. It settled within a week when he stopped training. He sought no
treatment.
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Predict the main physical findings.
Observation –
Capsuloligamentous- anterior inferior capsular laxity on the right compared with the left -
posterior capsule tight - horizontal flexion 10° short of neutral before scapula moves.