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Shoulder Assessment Form

NameDate

SUBJECTIVE HISTORY

Date of InjuryDate of SurgeryMechanism of Injury

History of neck pain / trauma / stiffness Yes No

Pins & Needles / Numbness Yes No

Night Pain Yes No

Morning Pain / Stiffness Yes No

Preferred sleeping position & has it been modified? If so, how?Aggravating Factors:Easing Factors & time to ease?Past Medical History:Previous Investigations:Previous Investigations:History of allergies, steroids or anti-coagulants?

IMPRESSION

Severity Acute Sub Acute Chronic

Nature Neurogenic Articular Soft Tissue Other

Irritability:

OBJECTIVE

Red Flags - Tick if present: Trauma Consistent non-mechanical pain Thoracic Pain Structural Deformity Hot and / or swollen joints Systemic Steroids Weight Loss Drug abuse Past history of cancer TB / HIV Systemically unwell Widespread neurological changes Marked neurological deterioration

Scapula Position:Humeral Head Posture:Comment on palpation findings such as skin temp, lumps, bumps, muscles & bony structure:Comment on the presence of hyper mobility:

Cervical Movement - Full AROM Yes No

Cervical Movement - Pain Present Yes No

Cervical Movement - Tingling Present indicating Neuro Traction Yes No

Cervical Movement - Numbness Present indicating Neuro Compression Yes No

Comment on Flexion / Extension, Rotation, Side bending, Combined Rotation + Flexion / Extension on the left and right:

Functional Shoulder Movements

Movements Scratch Head Left & Right Touch opposite shoulder Left & Right Scratch back Left & Right

Apply Scratch Test: Abduction & External Rotation Limitation on the Left or Right:Screenshot%202024-07-10%20at%2010.54.28.668e4c5f234fd4.55111969Apply Scratch Test: Abduction & Internal Rotation Limitation on the Left or Right:Screenshot%202024-07-10%20at%2010.54.33.668e4c752455c2.31815447Comment on: Scapular / humeral activity during movement / abdominal & pelvic muscle control.

Allocate limitations in the following shoulder AROM: Flexion Abduction Extension IR Elbows by side (0 deg) IR Elbows at 90 deg Horizontal Flexion ER Elbows by side (0 deg) ER Elbows at 90 deg

Manual Muscle Test - Indicate if less than Grade 4 Flexion Abduction Extension IR Elbows by side at 0 deg IR Elbows by side at 90 deg Horizontal Ext Horizontal Flex ER Elbows by side at 0 deg ER Elbows at 90 deg

SPECIFIC TESTS

Impingement Tests - Indicate if positive and comment below Left / Right Painful Arc Full Can Empty Can Biceps at 90 deg with elbows extended

Impingement Tests - Tick as appropriate Left Right

Rotator Cuff Tests - Indicate if positive and comment below Left / Right / Pain / Weakness / Lag Supraspinatus Subscapularis Infraspinatus Teres Minor Biceps

Rotator Cuff Tests - Comments

Instability Tests - Indicate if positive and comment below Left / Right Apprehension Sulcus Anterior Instability Posterior Instability

If Instability Tests are positive - don't do the other tests.

Labral Tests - Indicate if positive and comment below Left / Right Active compression Provocation Test Crank test ACJ (Passive Horizontal Flexion 120 deg)

Comments

Neurological Tests - Indicate if positive and comment below Left / Right Reflexes Light Touch ULTT

Comments

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