This is a follow up to my previous article  where I described the anatomy of the rotator cuff (FIGURE 1) and how it may become injured. If a rotator cuff injury, such as a tendinitis or a partial tear, does occur it is important to have this assessed by a trained health professional. A competent examination will help you find a diagnosis and will determine the contributing factors to your injury. This will guide your therapist in developing an effective treatment plan, tailored to your individual needs.

Let me take you through the essential components of an assessment for a suspected rotator cuff injury.

 

 

 

 

 

 

(FIGURE 1: The rotator cuff is made up of 4 muscles which work to stabilize the shoulder)

Subjective Assessment

At the Orthopaedic Therapy Clinic, the examination is provided one-on-one with a registered physical therapist.  It begins with a subjective assessment. Your physical therapist will ask evidence-based questions to rule a rotator cuff injury in or out. Some of the topics covered will include:

  • Age and gender
  • Location and nature of pain
  • Presence of other symptoms such as numbness, tingling, clicking, stiffness, etc.
  • Activities that make the pain worse/Activities that make the pain better
  • Past Medical History
  • Previous injury in shoulder
  • Occupation and physical demands of job
  • Activity preferences
  • X-ray, ultrasound or MRI results

In addition to these topics, other factors that may be explored include: History of anxiety/depression, expectations for recovery, degree of social support systems, beliefs about pain, and pain behaviours such as avoidance of movement. All of these factors are important and have been associated with prognosis in shoulder pain recovery1. Finally, your physical therapist will help you to set a goal, so that you can work towards a specific task to determine degree of recovery.

Physical Examination

After the completion of the interview, your physical therapist will take you through a physical examination. The goal of this examination is to determine your shoulder mobility and strength and the structural integrity of relevant structures.

To begin, your physical therapist will observe your posture. This will include the positioning of your shoulder and shoulder blade as well as the curvature of your neck and mid-back. Next your physical therapist will have you complete various movements such as overhead reaching and rotations to determine your range of motion as well as the presence of any pain with these movements. Additionally, your physical therapist may try to alter the painful movements by changing the posture of the shoulder or shoulder blade to determine if your aggravating activity may be modified.

Next, your physical therapist will test the strength of your shoulder in various positions. As muscles weakness is a common feature in rotator cuff pathology, this will be a helpful test to allow your physical therapist to rule in or out a cuff problem. This may also help the therapist guide exercise prescription, as they may choose to prescribe exercises to strengthen the muscles involved with the weakened movements.

Your physical therapist may also choose to perform certain tests (FIGURE 2) to determine which specific structures may be involved. These tests will help determine which of the 4 rotator cuff muscles are involved, and if a cuff pathology truly exists. Finally, your physical therapist may choose to palpate structures around the shoulder to determine which of them may be painful or tight.

 

 

 

 

 

(FIGURE 2: The Hawkins-Kennedy test is a popular manoeuvre to determine presence of rotator cuff injury)

Conclusion

A strong physical examination combined with a thorough history involving the above topics will allow your physical therapist to determine an accurate diagnosis for your shoulder pain. These diagnoses may include rotator cuff pathology, labral tear, frozen shoulder, shoulder osteoarthritis or shoulder pain referred from the neck. If the diagnosis is indeed a rotator cuff injury, there are many effective treatments that may be employed. This will be discussed in the part 3 of my rotator cuff series!

I encourage you to reflect on the contents of this article if you are currently experiencing shoulder pain. Try to determine what the contributing factors to your pain are and what movements/positions are aggravating. If you need assistance with these things I suggest you contact a health professional for a full assessment.

To complete an assessment for a suspected rotator cuff injury or other shoulder pain, contact Taylor Sipos, Registered Physiotherapist, by calling the Orthopaedic Therapy Clinic at (416) 925-4687 or emailing tsipos@orthophysio.com

References

[1] Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2018). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. British journal of sports medicine52(4), 269-275.

Figure 1: https://www.orthobethesda.com/blog/rotator-cuff-disorders-the-facts/

Figure 2: https://quizlet.com/120876735/shoulder-special-tests-flash-cards/