Patients Name

DOB
MRN
Date of Visit

Shoulder Pain H & P

HPI

KEY: Y = Yes (positive)

N = No (negative)

NE= Not Examined

History elements to ask:

- Neck pain
- Radiation of pain
- Provoking/alleviating factors
o
- Painful arc (60-120 abduction)
- Activities limited

- Onset of symptoms
- Mechanism of injury/ History of trauma or injury
- Acute traumatic, overuse, or spontaneous onset
- Pop or dislocation with injury
- Location of pain

PMH
Prior shoulder injury or instability
Prior shoulder surgery
Other orthopedic history (surgeries, arthritis, trauma, injuries etc)

--------------------------------------------------------------------------------------------------------------------------------------------------Physical Exam
Inspection
Swelling
Y
N
NE
Erythema
Y
N
NE
Bruising
Y
N
NE
Atrophy
Y
N
NE
Other deformity:________________________________
ROM (full active/passive)
Flexion
Abduction
Cross Body Adduction
External rotation
Internal rotation
Winging of scapula
Scapular dyskinesis
Cervical

Y
Y
Y
Y
Y
Y
Y
Y

N
N
N
N
N
N
N
N

NE
NE
NE
NE
NE
NE
NE
NE

Strength
Abduction
External Rotation
Internal rotation
Empty can test (supraspinatus)
Lift-off test (subscapularis)
Drop Arm Test (supraspinatus)

Y
Y
Y
Y
Y
Y

N
N
N
N
N
N

NE
NE
NE
NE
NE
NE

Special Tests
Impingement
Neers test
Hawkins test
Biceps Tendinitis
Speeds test
Labral Tear
OBriens Test
Crank Test
Instability Tests
Apprehension test
Relocation maneuver

Y
Y

N
N

NE
NE

NE

Y
Y

N
N

NE
NE

Y
Y

N
N

NE
NE

Palpation (pain elicited)

Sternoclavicular (SC) joint
Clavicle
Acromioclavicular (AC) joint
Greater tuberosity
Subacromial
Biciptal Groove

Y
Y
Y
Y
Y
Y

N
N
N
N
N
N

NE
NE
NE
NE
NE
NE

Neurovascular
Sensation

NE

NE

Distal pulses

Assessment (circle suspected diagnosis)

AC joint arthritis
AC joint separation
Adhesive capsulitis (Frozen shoulder)
Biceps tendonitis
Biceps tendon rupture
Brachial plexopathy

Calcific tendonitis/bursitis
Clavicular fracture
Glenohumeral joint osteoarthritis
Greater tuberosity avulsion fracture
Multidirectional instability
Rheumatoid arthritis

Rotator cuff tear

Rotator cuff tendonopathy
Shoulder dislocation/subluxation
Subacromial bursitis
Subacromial impingement
Other:_____________________________

Plan
1) Treatment (Circle all employed)
Rest, activity modification, ice
Shoulder Immobilizer/Sling
Exercises: (specify)___________________________
Aspiration/Injection:______________________________
2) Medications
NSAIDs
Y
N
Specify:________________________
Other:_____________________________________
3) Imaging
X-rays
Y
N
MRI
Y
N
If yes, specify test ordered:_____________________
4) Referral
Sports Med
Y
N
Orthopedics
Y
N
Physical Therapy
Y
N
5) Follow up: ______________
Ashwin Rao and Jonathan Drezner, 2007

Figures 1 & 2: Shoulder Anatomy- Figure 1 demonstrates muscular landmarks, including rotator cuff attachments. The supraspinatus inserts most superiorly, followed
by the infraspinatus, teres minor, and subscapularis. Figure 2 more clearly identifies the 3 joints of the shoulder (SC, AC, glenohumeral) as well as other bony landmarks

Figure 3- Empty Can Test: Elevate the arms

against resistance with elbows extended, the
arms abducted and the thumbs pointing
downward. Assesses for supraspinatus injury

Figure 4-External Rotation Test: Externally rotate the

arms against resistance, while te arms are at the side and
the elbows are flexed to 90 degrees. Assesses for teres
minor and infraspinatus injury.

Figure 5- Lift Off Test: Place 1 hand

behind the back and push out against
resistance. Assesses for subscapularis
injury.

Figure 6- Neers Impingment Test: Fully Pronate

the arm and then flex at the shoulder against
resistance. Asesseses test for impingement of the
rotator cuff tendons under the coracoacromial arch.

Figure 7 -Hawkins Test: Elevate shoulder to 90o, while

keeping elbow flexed at 90 o. Support the arm and then
internally rotate the humerus. Pain with this maneuver
suggests subacromial impingement of rotator cuff injury.

Figure 8-Cross-Body Adduction: Adduct

arm passively across body. Pain at AC
joint indicates injury or arthritis.

Figure 9- Speeds Test: Flex

the elbow against resistance.
Pain indicates biceps tendonitis
or injury

Figure 10-Crank Test: Abduct shoulder to 90 o and

slowly internally rotate while a gentle axial load is
applied to the glenohumeral joint. Pain, catching, or
grinding in the shoulder indicates a labral tear (SLAP
lesion).

Figure 11- Apprehension Test: Abduct shoulder to

while the arm is externally rotated with concominant
anterior pressure to the humerus. A sense of
instability with this maneuver suggests anterior
instability due to a labral tear.