History:

1. Mechanism of injury or when did they begin to have signs and symptoms

2. Hand dominance- dominant shoulder injury versus non dominant shoulder

3. Is this an acute injury or chronic?

a. What were they doing at the exact moment of injury?
b. How have the symptoms progressed?

4. What is their activity level?

a. Athlete
b. What sports are they involved in?

5. What is their goal?

6. What are their expectations of rehab?

7. Do they have any other symptoms? Neck pain, etc…

Physical Examination:

1. Observe for splinting, natural arm movement

2. Functional mobility (ex. getting dressed)

3. Asymmetry or muscle atrophy

4. Range of motion

a. quantity
b. quality- when does pain occur
c. compensations- scapulothoracic movement (shoulder
blade moving too much)
d. functional mobility

5. Strength testing- quantifiable measurements

a. internal rotators (front rotator cuff muscles)
b. external rotators (back rotator cuff muscles)
c. supraspinatus (top rotator cuff muscle)
d. deltoids
e. scapular stabilizers

6. Palpation of muscles, tendons, and bony landmarks

7. Special tests (positive if)

a. Speeds test- pain in proximal biceps tendon resisted shoulder flexion (at 60 degrees) with forearm supinated (palm up) and elbow extended
b. Yergason’s test- pain in proximal biceps tendon with resisted supination of the forearm with the elbow flexed at 90 degrees
c. Empty can- pain and decreased strength
d. Sulcus sign- increase in inferior excursion of the humerus with long axis distraction (graded 1-3 based on cm of movement)
e. Anterior/Posterior stability- (load-shift test resulting in increased translation) humeral head cupped with one hand and clavicle/scapula cupped with other. Provide antero/medial force for anterior stability and posterior/lateral force for posterior stability.
f. Apprehension- (look of apprehension) with combined Abduction and External Rotation
g. Impingement sign- (pain with) abducted shoulder to 90 degrees and internally rotating the arm in varied degrees of flexion

Treatment:

Initially the RICE (Rest Ice Compress Elevate) principle should be enforced.
Proper biomechanics are very important with most shoulder injuries especially ones that are chronic in nature. Consult with your rehab specialist for proper stretching techniques to improve flexibility to structures specific to your sport.
Rotator cuff strengthening is an integral part treatment and prevention for athletes that perform sports that involve overhead activities. The rotator cuff musculature assists in stabilizing the shoulder and allowing proper movement of the ball in the socket. To strengthen these structures perform the following:

1. Supraspinatus- starting with your arm in front of you- move your arm half way between the front of your leg and the outside of your thigh, with the thumb pointing up slowly raise and lower the arm to shoulder height. Perform this 10 times initially without weight and repeat 3 times. As you have less pain and are able to perform this easier add 1 # increments until you reach 5 #.

2. External rotators (muscles in the back of the shoulder)- lie on your uninjured side with the elbow at a 90degree angle. Slowly rotate the arm up so that when you are finished the fingers should be pointing at the ceiling. Perform 10 reps and repeat 3 times. (Again add 1# increments until you reach 5#, this should be done over a course of several weeks)

3. Internal rotators (muscles in the front of the shoulder)- lie on your sore shoulder (if this is painful support yourself with your uninjured arm), rotate your arm so that your fingers are pointing toward the ceiling. Perform 10 times and repeat 3 sets. Increase in weight as noted above.

This is a basic treatment program. You should consult your physician, trainer or therapist for additional information and more comprehensive program.