When a client comes in with shoulder pain, how many of us do assessments? Being capable of performing 10 movements – some say 11 depending on if you look at the scapulothoracic – the shoulder is a complex joint. With these movements, injuries and dysfunctions can easily happen leading to rotator cuff tears, nerve impingements, tendinopathies, and sometimes frozen shoulder. But which is it? The importance of assessing is critical to help the therapists decide on the correct treatment protocol.
As the old saying implies, it’s best practice to avoid assuming; and therefore, one should start with assessments. There are a couple structures to look at when we assess the shoulder. The first is the sternoclavicular joint or (SC). This is usually overlooked and can be a key player in the shoulder dysfunction. To perform the assessment, place both of your index fingers on the superior aspects of the clavicle where it connects with the sternum. Ask the client to shrug the shoulders and look for the clavicle heads to drop. If the outcome has one finger higher, this is the dysfunctional structure.
The next joint to assess is the Acromioclavicular Joint or (AC). To assess movement at the AC joint, put the client into abduction to 90 degrees and flex the elbow to 90 degrees. Then adduct the shoulder to 30 degrees to isolate the AC joint. Test for internal and external rotation while keeping the fingers on the AC joint to monitor restrictions. Take note of any identified restrictions.
There are several other assessments that can be utilized to assess the shoulder; however, I wanted to express the importance of thoracic spine and scapula stabilization. Having adequate motion in the thoracic spine is essential for the scapula to stabilize during shoulder movements. Giving clients home training exercises is great way to teach scapula stabilization and retrain the brain on the proper mechanics.
Try assessing the client the next time they come in complaining of shoulder pain. Visit our FB page and check out our podcasts to get more information on how to assess and treat shoulder pain.