Shoulder pain is a common concern that can significantly impact daily activities and overall quality of life. The term “periarthritis shoulder” broadly refers to inflammation and discomfort in the tissues surrounding the shoulder joint. Identifying the precise cause of this pain is an important step towards effective management and recovery. A thorough evaluation, often involving specific physical tests, helps healthcare professionals understand the underlying issue.
Understanding Periarthritis Shoulder and Diagnostic Needs
Periarthritis shoulder encompasses a range of conditions characterized by inflammation and pain in the soft tissues around the shoulder joint. This can include issues like tendinitis, which is inflammation of a tendon, or bursitis, which involves inflammation of the fluid-filled sacs that cushion the joints. In some instances, it may also refer to adhesive capsulitis, commonly known as frozen shoulder, where the joint capsule thickens and tightens, leading to stiffness and reduced motion. Calcium deposits around the joint can also contribute to this inflammation.
Since various conditions present with similar symptoms like pain, stiffness, and tenderness, specific diagnostic methods are needed. These tests differentiate between potential issues, ensuring the treatment plan is tailored to the specific condition and improves recovery.
Specific Physical Tests for Shoulder Conditions
Healthcare professionals employ a variety of “special tests” during a physical examination to assess different structures of the shoulder. These tests help evaluate concerns such as range of motion, potential impingement, the integrity of the rotator cuff muscles, issues with the biceps tendon, and problems within the acromioclavicular (AC) joint. Each test is designed to provoke symptoms or reveal weaknesses in a specific area, guiding the diagnosis.
For instance, to assess for shoulder impingement, the Neer’s Test and Hawkins-Kennedy Test are commonly performed. During Neer’s Test, the examiner stabilizes the shoulder blade and passively raises the patient’s arm overhead while internally rotated, looking for pain. The Hawkins-Kennedy Test involves flexing the arm and elbow to 90 degrees, then internally rotating the shoulder, with pain indicating impingement. Another test, the Painful Arc, involves the patient actively raising their arm; pain between 60 and 120 degrees of abduction can suggest impingement.
To evaluate the rotator cuff, which consists of four muscles, tests like the Empty Can Test are used for the supraspinatus muscle. In this test, the arm is raised to 90 degrees of abduction and 30 degrees forward flexion with the thumb pointing down, and the patient resists downward pressure. The Drop-Arm Test assesses for a full-thickness rotator cuff tear; the patient’s arm is passively raised, and they are asked to slowly lower it, with an inability to do so smoothly or a sudden drop indicating a positive result. External rotation resistance tests can help identify issues with the infraspinatus and teres minor muscles.
For concerns related to the biceps tendon or a superior labral anterior posterior (SLAP) lesion, tests like Speed’s Test and Yergason’s Test are utilized. Speed’s Test involves the patient extending their elbow and supinating their forearm, then flexing their shoulder to 90 degrees and resisting downward pressure, with pain in the bicipital groove suggesting a problem. Yergason’s Test involves resisting external rotation and supination of the forearm, with pain or a clicking sensation indicating biceps tendon issues. The O’Brien’s Test can also assess for AC joint injury or labral pathology; the arm is flexed forward with the thumb down, and the patient resists downward pressure, then the test is repeated with the palm up, comparing pain levels.
What Happens During a Shoulder Examination
A physical examination of the shoulder begins with the healthcare professional observing the patient’s posture and the symmetry of both shoulders, looking for any visible abnormalities, swelling, or muscle wasting. This initial inspection provides clues about potential issues. Following observation, the examiner gently palpates, or feels, various structures around the shoulder, including bones, joints, and tendons, to identify areas of tenderness, warmth, or swelling.
Movement testing follows, starting with active range of motion where the patient moves their arm in different directions, such as flexion, extension, abduction, and rotation. The doctor observes the ease and extent of these movements, noting any limitations or pain. Passive range of motion is then assessed, where the examiner moves the patient’s arm through its full range of motion to determine if there are restrictions not present during active movement.
Finally, the specific special tests are performed, which involve the doctor moving the patient’s arm in particular ways and often applying gentle resistance or pressure. These maneuvers are designed to stress specific tendons, ligaments, or joint structures to reproduce symptoms or reveal instability. Throughout this process, the doctor will ask the patient about any pain, clicking, or apprehension experienced, using this feedback to interpret the test results.
Comprehensive Diagnosis of Shoulder Pain
While special physical tests are an important part of the diagnostic process, they are rarely used in isolation. A comprehensive diagnosis of shoulder pain integrates several components to form a complete picture of the patient’s condition, ensuring accuracy and an effective treatment strategy.
A detailed medical history is the first step, where the healthcare professional gathers information about the pain’s onset, duration, and nature, as well as any previous injuries or medical conditions. This history provides valuable context and helps narrow down potential causes. Findings from the physical examination, including special tests, are then combined with this historical information.
In many cases, imaging studies are also utilized to confirm a diagnosis or rule out other conditions not evident through physical examination alone. X-rays can reveal bone issues like fractures or arthritis. Magnetic resonance imaging (MRI) provides detailed images of soft tissues like tendons, ligaments, and cartilage, useful for diagnosing tears or inflammation. Ultrasound can also be used for dynamic imaging and to assess soft tissues. By integrating all these findings, a qualified healthcare professional can arrive at an accurate diagnosis and formulate a personalized treatment plan.