Shoulder

Shoulder & Upper Arm History

Demographics

Age
- < 30
  - instability
  - very rare to have complete cuff tear
- > 45
  - degenerative joint disease
  - RC tears
    - If cuff tear under 40 years old, then think
      - instability
      - manual labourer
      - throwing / overhead athlete
  - Adhesive capsulitis
Occupation
Handedness

Presenting Complaints

Pain

Where
- Rotator Cuff
  - anterolateral & superior
  - deltoid insertion
- Bicipital tendonitis
  - Referred to elbow
Radiation
Type
Severity
Onset
- when did it start
- how did it start
  - acute
    - trauma
  - chronic
    - degenerative
Duration
Progression
- worse, better, same
Nocte, rest, constant
Aggravating / Relieving factors
- Position that ↑ symptoms
  - RC: Window cleaning position
  - Instability: when arm is overhead
- Neck pain
  - Is shoulder pain related to neck pain
  - If neck pain
    - Then ask about radiculopathy
Causes
- AC joint
- Cervical Spine
- Glenohumeral joint & rotator cuff
  - Front & outer aspect of joint
  - Radiates to middle of arm
- Rotator cuff impingement
  - Positional : appears in the window cleaning position
- Instability
  - Comes on suddenly when the arm is held high overhead
- Referred pain
  - Mediastinal disorders, cardiac ischaemia
Associated
- Stiffness
- Instability / Gives way
  - Severe – feeling of joint dislocating
  - Usually more subtle presenting with clicks/jerks
  - What position
  - Initial trauma
  - How often
  - Ligamentous laxity
- Clicking, Catching / grinding
  - If so, what position
- Weakness
  - Rotator cuff
    - especially if large tear
- Pins & needles, numbness
Loss of function
- Home
  - Dressing
    - Coat
    - Bra
  - Grooming
    - Toilet
    - Brushing hair
  - Lift objects

Difficulty working with arm above shoulder height
- Top shelves
- Hanging washing
Work
Sport
Previous Treatment
- Nonoperative
  - medications
  - injections
  - physiotherapy
- Operative
Past Medical History
- Previous trauma
- Previous surgery
Family History
- Ligamenous laxity
- MDI