Shoulder Evaluation: What to Expect

Overview

The shoulder joint, as we commonly refer to it, is called the glenohumeral joint: where the humerus (upper arm bone) meets an area of the scapula (shoulder blade) called the glenoid fossa.  There are other smaller joints within the shoulder itself, but this is the largest one that is typically thought of when discussing the shoulder in common language.

Similar to the hip, the shoulder is a ball and socket joint, inherently very mobile with the ability to move in three separate planes of motion.  The movements of the glenohumeral joint include flexion (reaching forward over head), extension (reaching backwards), abduction (bringing your arm away from your body), adduction (reaching across your body to the other side), external rotation (think baseball pitcher wind up), and internal rotation (think sleeper stretch or reaching to itch your lower back).  With all of this mobility available at the shoulder, can you guess what is important to train?  Yes- stability!  Many of the common deficits we see at the shoulder have a component of instability to them, reinforcing the importance of having control over the mobility we utilize and training all those little muscles around the shoulder to support everything staying in its optimal position when both at rest and when active.

What can I expect at my physical therapy evaluation?

There is a lot that goes into evaluation of shoulder pain/weakness/imbalance/insert symptom, however here are some major areas that will be covered in your assessment: 

• Active range of motion (you moving through all the motions discussed above, conversation around if any of these motions reproduce your pain or symptoms, comparison of your healthy side to your injured/involved/unhealthy side, etc.)

• Passive range of motion- when we move you through different motions is your motion increased? Less painful?  This is all helpful information to guide treatment!

• Strength tests of different muscles or muscle groups involved in you moving through the active range of motion tests discussed above

• Functional movements required for daily activities like reaching up your low back for dressing, reaching behind your head or down your back to wash your hair, but also movements you work on in the gym like push up variations, pulling movements, and more

• Visual and physical assessment of how your shoulder blades themselves are moving, if they are moving in coordination with one another and if they could be a contributing factor to your shoulder movement deficits

• Assessment of your upper back (thoracic spine)- are the joints mobile, stiff, hypermobile, sore to the touch?  How well can you achieve active movement through the spine?  

Common Findings

A major deficit that we see frequently in the clinic is the strength of what we call the periscapular muscles, or in other words, muscles around the shoulder blade.  Oftentimes the smaller muscles surrounding the shoulder blade are weaker than we ideally would like for them to be.  This is common because we tend to train and work the bigger muscles for movements like pushing and pulling, with less focus on training the muscles that provide rotation to the shoulder joint.  Similar deficits in strength and/or ability to actively control firing of a muscle occur in the muscle responsible for keeping our shoulder blades positioned properly against our rib cage with motion and at rest.  

As alluded to in everything discussed above, but not specifically stated yet, is the importance of looking at structures above or below the area of interest, those surrounding the shoulder with potential implications at how it functions.  This is where thoracic mobility comes into play, especially with overhead shoulder motions.  If our thoracic spine is very stiff and doesn’t flex, extend or rotate well, this can make it difficult to achieve proper end range of the glenohumeral joint in different positions.  

Summary

Hopefully you took away some great nuggets from this overview of what the shoulder does, how we can assess it, and some common deficits we see in the clinic.  This is a very general summary of a complex joint within the body.  Although shoulder pain is common, it doesn’t have to be normal.  And your shoulder pain/weakness/dysfunction is also very specific to you and your experience.  This is why we value providing you with individual, fitness-forward rehabilitation so that we can eradicate the current limitation and prevent it from occurring again!

What’s next?

Have more questions about your shoulder situation?  We would be happy to chat further about how Loon State Physical Therapy can be your teammate in getting you back to moving and feeling your best! Call us at (612) 405-8503 or book with us online at www.loonstatephysicaltherapy.com for an in-person or virtual appointment.

Loon State Physical Therapy