An initial evaluation of your injured shoulder is used to determine your problem areas, develop your rehabilitation program and monitor your progress. The evaluation is broken into history, inspection and palpation, range-of-motion, strength and special tests. An evaluation always precedes the start of a rehabilitation program, even if your physician evaluated you prior to prescribing physical therapy.
History
The history is where the physical therapist documents previous injuries, the cause of your injury and symptoms. The primary symptom you are suffering from, such as pain with overhead movement, is often referred to as the chief complaint. Additional information documented is the location of your pain and the type of pain you are experiencing, like whether the pain is sharp or achy. The timeline of previous injuries, your current injury and onset of symptoms are also noted.
Inspection and Palpation
In the inspection, your physical therapist observes your shoulder and posture, whereas palpation involves evaluating your shoulder through touching. The inspection helps to determine any deformity, swelling, redness or bruising and postural abnormalities, such as one shoulder lower than the other. Palpation is performed to feel for warmth and point tenderness, which indicate inflammation and the location of your injury, respectively. Other palpable abnormalities as a result of your injury include fluid build-up and crepitus, which is a crackling sensation over bone or tendons.
Range of Motion
Testing the range of motion of your shoulder helps the physical therapist to determine what muscles are tight and the severity of your injury. Bilateral comparison includes range-of-motion tests performed on both sides to compare the injured shoulder and the uninjured shoulder. Furthermore, range of motion can be tested with the physical therapist passively moving your shoulder or with you moving your shoulder, called active range of motion. Shoulder movements tested include flexion, extension, abduction, adduction, and internal and external rotation.
Strength
Using similar movements as those used for range of motion, your physical therapist applies resistance to find areas of weakness and pain. A numbering system or specific categories are used to measure your muscle strength. Cyraix's resistance testing, for example, classifies manual muscle strength into one of four categories: strong and painless, strong and painful, weak and painful or weak and painless. However, manual strength tests such as Cyriax's may lack reliability; therefore, your physical therapist should be well trained and follow strict testing guidelines to improve reliability, according to a 2003 Northwestern University study.
Special Tests
Shoulder joint instabilities and injuries are assessed using special tests. The "empty can" test, for example, is used to determine whether your supraspinatus muscle is injured or strained. Additional special tests include the Apley scratch test, drop-arm test, apprehension test and Adson's maneuver. Each test places the shoulder in different positions with the physical therapist manipulating your shoulder and soft tissue. If a test solicits pain or reproduces symptoms, it indicates a positive result.
References
- "Rehabilitation Techniques in Sports Medicine"; William E. Prentice; 1999
- "American Family Physician"; The Painful Shoulder: Part I Clinical Evaluation; Thomas W. Woodward, M.D., et al.; May 2000
- "Journal of Orthopaedic and Sports Physical Therapy"; Reliability of Classifications Derived From Cyriax's Resisted Testing in Subjects With Painful Shoulders and Knees; Karen W. Hayes, P.T., P.h.D, et al.; May 2003
