In physical therapy school, therapists are taught a broad spectrum of knowledge. Orthopedic examination, treatment, and prognosis is covered in-depth. For example, we learn more than 50 special tests to diagnose shoulder impingement, rotator cuff dysfunction, biceps pathology, and labral tears. Despite all this knowledge, therapists lack the ability to prioritize these tests. Many therapists gather information without considering ‘why’ we perform each measure. We soon realize that the special tests are not very special! Upon finishing their clinical examination, they are drowning in information that only minimally changes their patient’s prognosis or intervention selection. The therapist has found several secondary and tertiary impairments without identifying the primary cause of the problem. In this post, I am going to discuss how I perform a shoulder evaluation and review some of my regular day 1 shoulder exercises.
Shoulder Examination: Efficiency and Reliability
Understanding the biomechanics can be a great starting point for assessing a painful region of the body. A lack of mobility or stability in any local region can impact one's pain perception, altering their response to stimuli.
For new clinicians, it is important to develop an efficient and reliable examination. This combination of efficiency and reliability will minimize any redundancy of testing while maximizing time for treatment. Below is my template for performing an efficient examination. For the purpose of efficiency, it is divided by patient position. You will notice that only a few special tests are performed and the biggest focus is on assessing regional joint mobility.
Shoulder Interventions: Day 1 Treatment and More
Upon completion of the shoulder examination, the next step is selecting appropriate interventions. From my clinical experiences, the shoulder joint is typically irritable in the acute stages. Therefore your exercise selection and manual interventions should address the patient's pain. My Day 1 interventions heavily focus on desensitizing the painful tissue through graded tissue exposure. Additionally, I spend a significant amount of time discussing the different mechanisms that impact pain. These exercises often include range of motion exercises and posterior shoulder muscle activation. If the patient has low irritability, further strengthening and mobility exercises can be initiated early in the plan of care.
The video below discusses 3 common exercises I give to patients on the first day.
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Questions or comments?
Let us know what initial interventions you typically use when working with shoulder patients!
-Jim Heafner PT, DPT, OCS
8/12/2018 09:21:00 am
HI Dr. Heafner,
8/12/2018 09:21:57 pm
8/20/2022 12:20:17 am
I'm glad that you talked about the importance of the spine should be assessed properly for better information. I have a cousin who is an athlete that suffered an rotator cuff injury, and he asked last night if I had any idea what would be the best treatment to do. You did a great job of explaining the important factors of physical therapy, I'll be sure to tell him that consulting a trusted sports physical therapy service can help provide more information about the treatment.
9/26/2022 10:52:13 pm
I find it fascinating that doctors could easily determine the reason why your shoulder is hurting and they can also suggest treatments for it. My colleague is interested in trying out sports as his new hobby whenever there's work downtime. I believe finding a local orthopedic can help alleviate his anxiety towards injuries later on.
1/11/2023 08:51:50 pm
Shoulder pain symptoms can vary based on diagnosis, however, there are a few common symptoms. The onset of the pain can be gradual or sudden and the pain can either be a dull ache or sharp and severe pain. Some people feel that the pain is worsened by use, while others experience the pain constantly.
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