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Content

  • Epidemiology
  • Pathology
  • Classification
  • Natural History
  • History
  • Examination
  • Investigations
  • Management

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