Objective Assessment of the Shoulder
Introduction[edit | edit source]
At the end of our questioning from our subjective examination, we ought to be able to have a rough top three sort of injuries or locations that we think the patient's problem is coming from. And then we can narrow that down with our objective examination.
Causes of pain[edit | edit source]
History[edit | edit source]
Objective Assessment[edit | edit source]
Exclude Cx spine[edit | edit source]
Spurling's test
Arm squeeze test
STAR Assessment[edit | edit source]
Management options[edit | edit source]
Meaningful Task Analysis[edit | edit source]
ROM[edit | edit source]
Postural Ax[edit | edit source]
Active movement[edit | edit source]
Special tests[edit | edit source]
Crank Test
Hawkins-Kennedy Test
Posterior Instability
Anterior Instability
Posterior Impingement
Shoulder Symptom Modification Procedure[edit | edit source]
Described by Jeremy Lewis in 2009[1] the Shoulder Symptom Modification Procedure(SSMP) is a reliable[2] approach to the assessment of individuals with rotator cuff and subacromial pathology. SSMP is a set of four mechanical techniques used in a sequence while the patient performs a movement that reproduces their symptoms. The aim is to identify one or more methods that reduce their symptoms and/or increasing movement and function.[3] This tool offers a method to objectively assess the shoulder with the focus being to identify movements and techniques that might be contributing factors to the symptomatic movement and not to label the pathology or exact cause of pain and then utilise these movements and techniques as a means to guide treatment.
The SSMP techniques[4] involve:
- Alterations to thoracic kyphosis - The first procedures of the SSMP aim to determine the influence of increasing and decreasing the thoracic kyphosis on the presenting symptoms. If the thoracic manoeuvre reduces the symptoms by 100%, then the assessment is complete and treatment is initiated with a combination of postural awareness, exercise (including motor control during the provocative activity), and manual therapy (to ensure adequate joint and soft tissue compliance). In this scenario, the aim of treatment is to improve thoracic extension, especially during the identified provocative activity or activities
- Scapular positioning techniques - If the thoracic procedures do not or only partially alleviate symptoms, then symptom changes secondary to scapular procedures are assessed.
- Humeral head positioning procedures - If the scapular procedures do not fully alleviate symptoms, the clinician progresses to assess the effects of the humeral head procedures. The purpose of the procedures is to positively influence the patient’s symptoms by applying techniques that aim to depress, elevate, or anteriorly or posteriorly glide the humeral head.
- Pain and symptom neuromodulation procedure - If the first 3 stages of the SSMP do not completely alleviate or reduce symptoms, then the final stage of the SSMP (neuromodulation) involves assessing the influence of manual procedures, such as pressure-based procedures (aimed at the soft tissues and joints), that may modulate shoulder symptoms and are routinely performed throughout the cervical, thoracic, and shoulder regions.
- Rotator Cuff Tendinopathy: Navigating the Diagnosis Management Conundrum[5]
- SSMP Tool
- SSMP summary by Eleanor Richardson & Jeremy Lewis
Force Assessment[edit | edit source]
Joint Position Sense[edit | edit source]
- ↑ Lewis, J. S. (2009) Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? British Journal of Sports Medicine, Vol 43, pp. 259-264
- ↑ Lewis JS, McCreesh K, Barratt E, Hegedus EJ, Sim J. Inter-rater Reliability of the Shoulder Symptom Modification Procedure in People with Shoulder Pain. BMJ Open Sport & Exercise Medicine. 2016 Nov 1;2(1):e000181
- ↑ Eleanor Richardson & Jeremy Lewis. The Shoulder Symptom Modification Procedure (SSMP). https://www.shoulderdoc.co.uk/article/1478
- ↑ Lewis J, Mccreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating The Diagnosis-Management Conundrum. Journal Of Orthopaedic & Sports Physical Therapy. 2015 N
- ↑ Lewis J, McCreesh K, Roy JS, Ginn K. Rotator cuff tendinopathy: navigating the diagnosis-management conundrum. Journal of orthopaedic & sports physical therapy. 2015 Nov;45(11):923-37.
