Functional Shoulder Assessment: Anatomical Considerations and Method

Creator: Dr. Durgapriya M
Published: 2023-04-20T16:04:12

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The shoulder joint is an intricate joint that is movable in various directions. Pathologic conditions associated with the shoulder are difficult to be diagnosed.

Written by

Dr. Durgapriya M

Medically reviewed by

Dr. Anuj Nigam

April 20, 2023

July 17, 2023

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Contents

What Are the Anatomical Considerations for Functional Joint Assessment?
What Are the Associated Conditions of a Shoulder Joint?
How Do Clinicians Perform Basic Shoulder Assessments?

Introduction:

The shoulder joint is a complicated joint with structural and functional complexity and it is freely movable in various directions. The diverse range of motion in the shoulder joint increases the risk of injury and other pathologic conditions. The examination of the shoulder joint can be quite challenging. It is because of their distinctive structural and biomechanical changes, articulation with other joints, and increased probability to be injured both inside and outside the shoulder joint. Many special tests are performed in the assessment of the shoulder joints which are specific to the joint, structure, or condition. This article will discuss the assessment of the shoulder joint in detail.

What Are the Anatomical Considerations for Functional Joint Assessment?

The shoulder joint comprises four joints namely the glenohumeral joint, sternoclavicular joint, acromioclavicular joint, and scapulothoracic joint (floating joint).

It is where the upper arm bone (humerus) articulates with the shoulder girdle in a ball and socket pattern.
The acromion is the bony projection of the shoulder blade. The collarbone (clavicle) articulates with the acromion in the acromioclavicular joint.
The sternoclavicular joint is where the collarbone (clavicle) articulates with the breastbone (sternum).
The glenohumeral joint is responsible for the articulation of the upper arm to the trunk of the body.
The rotator cuff is the group of muscles (supraspinatus, subscapularis, infraspinatus, and teres minor muscle) and tendons that surround the shoulder joint and are necessary for the stabilization and movement of the shoulder.
The primary movements of the shoulder joints include flexion (action of bending), extension (opposite of flexion), abduction (moving away from the body), adduction (moving towards the body), and internal and external rotation.
Every movement of the shoulder joint always involves the glenohumeral joint, particularly in the elevation of the upper arm.

What Are the Associated Conditions of a Shoulder Joint?

Shoulder pain accounts for about one percent of the general population. Increased range of motion in these joints makes them more prone to injuries and various pathologies. Commonly associated conditions affecting the shoulder joint are given below.

Acute muscular conditions such as fractures, dislocation, and muscle injury.
Chronic muscular conditions such as rotator cuff tears, osteoarthritis, biceps long-head tendonitis, recurrent dislocations, neoplasia, and adhesive capsulitis.
Pathologic conditions associated with nerves include herpes zoster infection, cervical spine pathology, or brachial neuritis.
Inflammatory conditions.
Pain in the shoulder joint in association with gastrointestinal conditions.
Cervical disc disorders.

How Do Clinicians Perform Basic Shoulder Assessments?

Prior to performing the assessment of the shoulder, the clinicians will take a comprehensive and detailed history taking regarding the patient’s symptoms. The patient may complain of shoulder pain, instability, restricted movements, and stiffness in the shoulder joint. Following the history taking, the clinician will perform active and passive assessments of the shoulder joint.

Generally, shoulder pain is roughly categorized into three types based on the range of motion into following.

Limited range of motion with shoulder pain is noted in patients with frozen shoulders and osteoarthritis.
Shoulder pain without any limitations in the range of motion but involves painful abduction is noted in patients with pathological conditions of the rotator cuff with or without tendinopathy of bursitis or biceps.
Other complaints of the shoulder without a limited range of motion involve shoulder instability and other joint pathology.

Assessment of Active ROM: In order to determine the shoulder condition, the clinician starts by assessing the active range of motion first. This involves independent movements performed by the patients. During the active range of motion assessment, the clinician will examine the movements of the upper arm bone, shoulder blade, and collarbone. Patients are asked to perform various movements such as:

Elevation through abduction to assess the abduction movement. Normal values range from 170 to 180 degrees.
Elevation through forward flexion to assess the flexion. Normal values range from160 to 180 degrees.
Extension by bringing the arms back as much as possible to assess the extension movements. Normal values range from 50 to 60 degrees.
By flexing the elbows to 90 degrees, patients are asked to move their arms outwards without abduction. This is done to assess the external rotation. Normal values range from 80 to 90 degrees.
By extending the thumb backward and reaching as far as possible to the inferior aspects of the scapula. This is done to assess the internal rotation. Normal values range from 60 to 100 degrees.
By extending the arms in front of the body as much as possible to assess the adduction movement. Normal values range from 50 to 75 degrees.

Assessment of Passive ROM: In the passive range of motion assessment the examiner helps in controlling the movement of patients. During the assessment, the examiner will evaluate the range of motion in degrees and look for any discomfort or limitations in movement. The passive range of motion assessment involves:

Forward flexion in the glenohumeral joint.
Shoulder extension.
Adduction and abduction.
Horizontal abduction and adduction.
Passive horizontal abduction.
Glenohumeral rotation.
Internal rotation.

During this assessment, the examiner will compare the range of motion with the end feel of the affected shoulder and the other shoulder.

Special Tests: After the assessment of the active and passive range of motion of the shoulder joint, the examiner will perform various special tests to identify the specific pathology.

Clinical tests involved in the evaluation of patients with the following conditions

Neer Test: It is a simple test performed in the evaluation of shoulder impingement.
Speed’s Test: A special test performed in diagnosing biceps tendonitis.
Apprehension and Relocation Test: The examiner performs these tests while suspecting shoulder dislocation causing instability in the shoulder joint.
Sulcus Test: This test is performed by the examiner to diagnose shoulder instability.
Acromioclavicular Joint (AC) Compression Test: This test is conducted when the examiner suspects a separated AC joint.
Hawkins-Kennedy Test: This special test is one of the other tests performed to diagnose shoulder impingement.
Drop Arm Test: This test is conducted when the examiner suspects a rotator cuff tear in the shoulder.
Jobe Test: This test is also called the empty can test. It is used in evaluating the rotator cuff muscles, especially the supraspinatus muscle.
Lift-Off Test: This test is conducted when the examiner suspects a tear in the subscapularis tendon in the shoulder.

Further radiological investigations may be performed if necessary.

Conclusion:

Proper assessment of the shoulder joint involving detailed history taking and clinical examination of the shoulder and special tests are essential for the diagnosis of the shoulder pathology. Various tests are performed to assess the shoulder joint. The accuracy of the tests depends on the patient and the clinician. The clinician tailors individual methods for the assessment of shoulder joints considering the limitations of patients and their condition. Once the diagnosis is confirmed, the clinician will recommend further treatment options.

Frequently Asked Questions

1. What Are Some Effective Methods to Expedite the Healing of Shoulder Bursitis?

Some strategies to expedite the healing of shoulder bursitis include:
- Ensuring ample rest and refraining from overexertion.
- Icing the affected area for 15 minutes can aid in mitigating inflammation.
- Employing Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) to alleviate pain.
- Participating in physical therapy to boost flexibility and improve muscle strength.
- Using corticosteroid injections as a means to diminish inflammation.
- Leveraging ultrasound therapy to enhance blood circulation and expedite the healing process.

2. What Is the Sensation or Discomfort Associated With Shoulder Bursitis?

Shoulder bursitis often manifests as discomfort encircling the afflicted shoulder, intensifying during physical activities. Experiencing tenderness upon contact or pressure in the region is common, accompanied by noticeable swelling that contributes to stiffness. Elevating the arm can pose a challenge, potentially causing weakness due to the accompanying pain. On occasion, the discomfort may extend to the neck.

3. Are There Viable Treatment Options for Shoulder Bursitis?

Yes, there exists a range of effective treatment choices for shoulder bursitis. These encompass providing the shoulder with much-needed rest, administering pain relief medications, employing antibiotics when infections are present, incorporating physical therapy to enhance mobility, harnessing the benefits of heat therapy to boost blood circulation, and including a regimen of gradual strengthening exercises. In the event that these non-surgical approaches prove insufficient in alleviating the condition, a surgical solution may be contemplated. This surgical method involves the removal of the inflamed bursa through the use of an arthroscope.

4. Can Bursitis Resolve on Its Own Without Intervention?

The majority of individuals dealing with bursitis can naturally recover when the condition is mild, without the requirement for interventions, by simply allowing the body to heal through rest and avoiding strenuous activities. However, when infection comes into play, the use of antibiotics may become necessary. The pace of healing also hinges on age; younger individuals often possess a more robust capacity for swift recovery. Furthermore, embracing self-care practices like adjusting one's lifestyle and utilizing over-the-counter medications can contribute to expedited recuperation.

5. Is Shoulder Bursitis a Condition of Concern for One's Overall Health?

While shoulder bursitis may not pose a grave threat to one's general health, it undeniably has a considerable influence over a person's day-to-day well-being. The persistent pain, discomfort, and consequential limitations on physical activity can significantly erode one's quality of life. Neglected and left untreated, this condition can gradually encroach upon one's mental equilibrium, exacerbating chronic pain, imposing functional restrictions, and sapping muscle strength.

6. What Strategies Can Be Employed to Alleviate Shoulder Discomfort When Raising the Arm?

Some strategies that can be employed to alleviate shoulder discomfort when raising the arm include:
- Prioritizing sufficient rest while steering clear of repetitive motions.
- Harnessing the relief of ice therapy to quell inflammation.
- Using the soothing benefits of heat therapy to enhance blood circulation.
- Using anti-inflammatory medications to ease pain.
- Committing to a regimen of physical therapy to boost both flexibility and strength.
- Opting for supportive bracing to gently immobilize the shoulder, offering the much-needed respite it deserves.

7. Is the Shoulder Classified as a Hinge Joint?

The shoulder stands apart from hinge joints, like the elbows and knees, as it is categorized as a ball-and-socket joint. Unlike hinge joints, which predominantly allow movement along a single plane, the shoulder joint boasts complexity, offering a versatile spectrum of actions. These include flexion, which involves raising the arm forward, extension for moving it backward, internal rotation, external rotation, or even a seamless combination of these intricate movements.

8. Does the Shoulder Joint Fall Under the Category of a Ball-And-Socket Joint?

Yes, the shoulder joint falls into the category of a ball-and-socket joint, scientifically denoted as the glenohumeral joint. This intricate connection consists of two primary components: the rounded head of the humerus acting as the ball and the concave depression within the scapula, recognized as the glenoid fossa, serving as the socket. This specialized joint architecture grants a remarkable spectrum of motion possibilities.

9. Which Joint in the Body Is an Example of a Ball-And-Socket Joint?

The concept of a ball-and-socket joint finds a prominent illustration in the hip joint, and it also applies to the shoulder joint. In the case of the hip joint, the ball finds its form in the head of the thigh bone, while the socket resides within the pelvic bone. This joint assumes a vital role in facilitating activities such as walking, running, and bearing the body's weight, affording a rich spectrum of movements and actions.

10. Which Bones Come Together to Form the Shoulder Joint?

The shoulder joint is made of two bones, which include:
- Humerus: The upper arm bone boasts a distinctive rounded head, acting as the vital ball-like element within the joint.
- Scapula: Familiarly recognized as the shoulder blade, this bone houses a shallow, bowl-like depression referred to as the glenoid fossa, fulfilling the role of the joint's socket.
In unison, these two bone structures harmonize to create the joint, facilitating a diverse array of movements and actions.

11. Which Bones Come Together to Form the Shoulder Joint?

The shoulder joint is made of two bones, which include:
- Humerus: The upper arm bone boasts a distinctive rounded head, acting as the vital ball-like element within the joint.
- Scapula: Familiarly recognized as the shoulder blade, this bone houses a shallow, bowl-like depression referred to as the glenoid fossa, fulfilling the role of the joint's socket.
In unison, these two bone structures harmonize to create the joint, facilitating a diverse array of movements and actions.

12. What Is the Predominant Bone in the Shoulder Structure?

At the core of the shoulder's architecture lies the scapula, a distinct triangular bone nestled behind the rib cage. This bone consists of the glenoid fossa, a crucial element that shapes the shoulder joint. Protruding prominently from the scapula is the acromion, a significant bony extension. Adding to its intricate structure, the scapula also features the coracoid process found on its anterior side. Completing the ensemble is the spine of the scapula, a distinctive feature residing on its posterior aspect.

13. Is It Possible for Shoulder Pain to Be Triggered by Gas-Related Issues?

Yes, it is plausible for shoulder pain to be provoked by gas-related issues, a phenomenon often referred to as 'referred pain.' Excessive gas places pressure on the diaphragm, resulting in irritation. Bloating, too, has the potential to agitate nearby nerves. Furthermore, the discomfort stemming from heartburn can extend to affect not only the chest but also radiate to the back and shoulders.

14. What Internal Organ Might Be Responsible for Causing Right Shoulder Pain?

Among the internal organs capable of inducing right shoulder pain, one finds the gallbladder, lungs, heart, liver, and diaphragm. Gallstones, these hardened structures that can manifest within the gallbladder, have the potential to disrupt the normal bile flow, thereby giving rise to inflammation that results in referred pain to the shoulder. Furthermore, heart-related concerns, like angina, linked to inadequate oxygen levels in the blood, may extend their influence, causing referred pain in the shoulder.

15. How Long Does It Usually Take for a Shoulder Strain to Fully Recover?

Recovery from most shoulder strains generally spans six to eight weeks. Yet, when grappling with severe strains, the healing can stretch over three to five months. In the initial phase, which persists for one to two weeks, the focus centers on alleviating pain and discomfort. Subsequently, during the rehabilitation phase, the cornerstone is physical therapy, an essential component for reclaiming the full range of motion. It is typically after this extended timeframe of three to five months that individuals find themselves ready to resume their usual activities.

Sources

Dr. Anuj Nigam

Orthopedician and Traumatology

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