Functional evaluation in shoulder pathologies

Edited by Doctor Alessio Capobianco

In shoulder pathology, pain is almost always the symptom that leads the patient to the doctor for a specialist visit.
The clinical examination must be conducted in order to diagnose whether the pathology afflicting the patient really originates from the joint complex of the shoulder and what disease it is, but it is also necessary to understand the type of person to be evaluated.
The choice of the subsequent diagnostic therapeutic procedure is conditioned by the age, limitations, needs and expectations of the patient.
The evaluation of a rotator cuff lesion in an elderly person with modest functional needs is different from that of a young person who practices manual labor; just as the instability of a sedentary patient or a high-level competitive sportsman must be considered different.
The tools available for a precise classification of the patient and for an adequate diagnosis are represented by an "accurate medical history and a correct objective examination, based on the wise use and interpretation of the numerous functional tests.
The use of instrumental tests imaging, today increasingly sophisticated, must not lead to neglect a "careful clinical evaluation but must serve only as a summary and confirmation of a diagnosis, or at least of a diagnostic suspicion, both already obtained.

Anamnesis

An accurate collection of the patient's clinical history makes it possible to detect whether the pain referred to the shoulder really originates from that site or whether it is to be referred to a pathology of other anatomical structures. It is frequent that the pain referred to the shoulder actually comes from the rachis cervical: in this case, however, indicating the exact location, the patient places his hand on the upper surface of the shoulder, at the level of the clavicle and trapezius; moreover, the irradiation of pain along the upper limb, in radicular pathology, generally reaches the hand and fingers, while the pain that starts from the shoulder radiates up to and not beyond the elbow.
The parameters to be evaluated in the patient with shoulder disease are:

age;
work and sporting activity;
trauma;
type of pain.

L"age it can already address suspicions. The rupture of the rotator cuff on a degenerative basis is generally found in subjects over 45-50 years of age, while between 25 and 40 years the pathology of subacromial impingement is more frequent, as well as the unstable painful shoulder is typical of young people and sportsmen.
Often the origin of a painful shoulder is due to the type of work or sports; it is therefore necessary to investigate the kind of work that the person carries out or what "is the" sporting activity that he practices and at what level, in order to understand whether these activities involve lifting weights, if it is an activity overhead, such as whitewashing or if he practices throwing sports such as volleyball, water polo, baseball, or if still contact sports with a high incidence of traumas, eg. rugby and wrestling.
It may happen that a trauma, a possible cause of the anatomical damage, is long before the onset of symptoms and therefore the subject neglects to report it.
The type of pain reported is of fundamental importance in the differential diagnosis; it is therefore necessary to evaluate the location, irradiation, link with certain movements or postures, any nocturnal exacerbation and the modality of onset.

Physical examination

The physical examination of the shoulder is expressed in the following step: inspection, palpation, mobility e
specific functional tests, topic of our article, which are divided into: