Shoulder Pain Assessment Sheet

Patient Name: Haidar kdeih

Date: 24-10-2023

Personal Information:

 Age: 60
 Gender: male
 Occupation: ______
 Activity Level: Sedentary / Moderate / Active

Medical History:

 Any pre-existing medical conditions: ___________________

 Any recent injuries or accidents: ___________________
 Any surgeries related to the shoulder: tendon surgeries

Pain Description:

 Location of pain (mark on a shoulder diagram): anterior part of right shoulder

 Onset of pain (sudden / gradual): gradual
 Duration of pain (days / weeks / months): weeks
 Pain intensity (mild / moderate / severe): mild
 Pain type (aching, sharp, burning, etc.): aching
 Any aggravating factors (certain movements, activities): Abd, add, flexion
 Any relieving factors (rest, specific positions): rest

Functional Limitations: Difficulty with lifting, reaching, overhead activities, etc.: all
activity related to elevation hand or rotation

 Impact on daily activities (dressing, bathing, etc.): limitation of all activity relates
to hand elevation
 Impact on recreational activities (sports, hobbies): no activity

Range of Motion and Strength:

  Any limitations in shoulder range of motion (flexion, abduction, etc.): limitation of
flexion, abduction, adduction, external rotation
 Muscle weakness or imbalance in rotator cuff muscles, deltoids, etc.: all shoulder
muscle in week

Palpation and Physical Examination:

 Any tenderness or palpable abnormalities around the shoulder: rotator cuff is

tender
 Scapular movement and alignment assessment: limitation of scapula movement
 Observation of shoulder posture and alignment: round shoulder

Additional Information:

 Any other relevant information or observations: ___________________

Assessment and Plan:

 Brief summary of the assessment findings: patient have a muscle weakness and
limitation in ROM and he put a bracelet to hold the shoulder in neutral position
with elbow flex
 Proposed plan for further evaluation and treatment:
 short time goal: increase ROM, decrease pain, back to normal style of life,
strength muscle
 Result

Date

Normal Range of
Direction Movement Motion (Degrees)

140
Flexion Forward arm lift 0 - 180 degrees

60
Extension Backward arm lift 0 - 60 degrees

105
Abduction Outward arm lift 0 - 180 degrees

Arm moving toward body's 50

Adduction midline 0 - 50 degrees

40
External Rotation Outward shoulder rotation 0 - 90 degrees

60
Internal Rotation Inward shoulder rotation 0 - 70 degrees

Horizontal 35
Abduction Arm out to the side 0 - 45 degrees

Horizontal 130
Adduction Arm moving across the body 0 - 130 degrees

Scaption Arm at a 30-degree angle 0 - 180 degrees

 Result

Muscle Possible
Group Muscle Tested Test Name Procedure Positive Sign Implications

Patient seated 1+
or standing.
Examiner
Anterior Shoulder Flexion resists forward Weakness during Anterior deltoid
Deltoids Deltoid Test arm lift. resistance or pain weakness

Patient seated 1+
or standing.
Examiner
resists
Shoulder outward arm Weakness during Middle deltoid
Middle Deltoid Abduction Test lift. resistance or pain weakness

Patient prone, 3
arm hanging
off the table.
Examiner
resists
Posterior Shoulder backward arm Weakness during Posterior deltoid
Deltoid Extension Test lift. resistance or pain weakness

Rotator Supraspinatus Empty Can Test Patient seated Weakness during Supraspinatus 2
Cuff or standing. resistance or pain weakness or
Arm forward, impingement
thumb down.
Examiner
resists arm
 Result

Muscle Possible
Group Muscle Tested Test Name Procedure Positive Sign Implications

abduction.

Patient seated, 2
arm at side,
elbow bent to
90 degrees.
Examiner Infraspinatus
External Rotation resists external Weakness during weakness or
Infraspinatus Test rotation. resistance or pain impingement

Patient seated, 2
arm at side,
elbow bent to
90 degrees.
Examiner
resists external
rotation with
the arm in a Teres minor
External Rotation neutral Weakness during weakness or
Teres Minor Test (Alternative) position. resistance or pain impingement

Subscapularis Lift-Off Test Patient places Inability to lift hand Subscapularis 3

dorsum of off the back weakness or
hand on the impingement
lower back.
Examiner
resists internal
 Result

Muscle Possible
Group Muscle Tested Test Name Procedure Positive Sign Implications

rotation.

Patient pushes 2
against a wall.
Examiner
observes Serratus anterior
Scapular Serratus Scapular Winging scapular Scapula lifts away weakness or
Muscles Anterior Test winging. from the ribcage dysfunction

Patient prone, 2
arms at sides,
elbows bent.
Examiner
resists Rhomboid
Rhomboid scapular Weakness during weakness or
Rhomboids Strength Test retraction. resistance or pain dysfunction

Patient seated 2
or standing.
Examiner
resists Trapezius
Shoulder Shrug shoulder Weakness during weakness or
Trapezius Test shrugging. resistance or pain dysfunction
 Result

Possible
Test Name Purpose Procedure Positive Sign Implications

Patient seated or
standing. Examiner
stabilizes scapula Pain at the anterior Possible subacromial
Impingement and forcibly elevates shoulder during impingement or
Neer Test Assessment the arm. elevation rotator cuff issues

Patient seated.
Examiner flexes the
shoulder to 90
degrees and then Possible subacromial
Hawkins- Impingement forcibly internally Pain during internal impingement or
Kennedy Test Assessment rotates the arm. rotation rotator cuff issues

Patient seated or Positive

standing. Arm
forward, thumb Possible
down. Examiner supraspinatus
Empty Can Supraspinatus resists arm Weakness during weakness or
Test Assessment abduction. abduction or pain impingement

Patient seated or
standing. Patient
Rotator Cuff actively abducts the
Integrity arm to 90 degrees, Inability to maintain Possible rotator cuff
Drop Arm Test Assessment then slowly lowers it. arm position tear or weakness
 Result

Possible
Test Name Purpose Procedure Positive Sign Implications

Patient places
dorsum of hand on
the lower back. Possible
Subscapularis Examiner resists Inability to lift hand subscapularis tear or
Lift-Off Test Assessment internal rotation. off the back weakness

Patient supine, arm

abducted to 90
Anterior degrees. Examiner
Shoulder externally rotates the Apprehension or
Apprehension Instability arm while applying resistance to the Possible anterior
Test Assessment anterior force. movement shoulder instability

Patient seated or
Inferior standing. Examiner
Shoulder grasps the humerus Visible or palpable Possible inferior
Sulcus Sign Instability and applies space/sulcus at the shoulder instability or
Test Assessment downward traction. shoulder joint laxity

Patient seated or
standing. Examiner
resists supination
and elbow flexion
Biceps Tendon while the patient Possible biceps
Integrity flexes the elbow Pain or "popping" tendon instability or
Yergason Test Assessment against resistance. sensation issues
 Result

Possible
Test Name Purpose Procedure Positive Sign Implications

Patient seated or
standing. Examiner
resists shoulder
Biceps Tendon flexion while the Pain or tenderness Possible biceps
Integrity patient keeps the at the bicipital tendonitis or labral
Speed's Test Assessment elbow extended. groove issues

Patient stands with

arm abducted to 90
degrees, elbow
extended, and palm
O'Brien's Test turned down. Possible SLAP
(Active Examiner applies (Superior Labrum
Compression SLAP Lesion downward pressure Pain or clicking Anterior to Posterior)
Test) Assessment as the patient resists. during the test lesion

Patient actively
adducts the arm
across the body.
Cross-Body AC Joint or Examiner applies Pain or discomfort Possible AC joint
Adduction Acromion downward pressure at the AC joint or pathology or
Test Assessment on the arm. acromion impingement