Shoulder

The prerequisite to any treatment of a patient with pain in the shoulder region is a precise and comprehensive picture of the signs and symptoms as they present during the assessment and as they existed until that time. This knowledge ensures that the techniques used will suit the condition and that the degree of success will be estimated against this background. Shoulder pain can be caused by intrinsic disease of the shoulder joints or pathology in the structures around it, or it may originate from the cervical spine, chest, or visceral structures. Pathology is commonly related to the level of activity, and age can play a significant role. The shoulder complex is difficult to assess because of its many structures (most of which are located in a small area), its many movements, and the many lesions that can occur either inside or outside the joints. Influences such as referred pain from the cervical spine and the possibility of more than one lesion being present at one time, as well as the difficulty in deciding what weight to give to each response, make the examination even more difficult to understand. Assessment of the shoulder region often necessitates an evaluation of the cervical spine to rule out referred symptoms, and the examiner must be prepared to include the cervical spine and its scanning examination in any shoulder assessment.