Shoulder pain assessment

 

 

Symptoms:

Pain in the right shoulder (rhomboid area).

Visual assessment:

Left externally rotated hip and extended
Higher right hip
Abducted and depressed right shoulder

Shoulder flexion movement:

The rhomboid and levator scapula dominate the movement as the scapula is retracted and elevated to achieve upward rotation.

During the phase of lowering the arm the right scapula downwardly rotates faster then the left and the Shoulder is hiked up. This may be caused by a weak serratus anterior that cannot maintain the load of the arm.

 

Shoulder abduction:

The dominance of the retractors and insufficiency of the serratus anterior is even more pronounced in shoulder abduction as the scapula is hiked up and starts its movement from await ion of extreme retraction.

Shoulder flexion against a wall:

THe shoulder flexion movement can be seen to be more controlled against the wall, this is due to the biofeedback and the reduced load of the arm. This is a good way to groove proper upward rotation of the scapula.

Apleys scratch test:
Both shoulder perform well for he apleys scratch test which leads me to believe there is no rotator cuff deficiency an that the problem resides in the scapula-thoracic complex.

Conclusion:

Efforts should be made to increase the strength of the right serratus anterior and to involve it functionally into the movements of shoulder flexion and abduction.

The left hip is interestingly externally rotated and extended but as it is asymptomatic no intervention should be made.

6 months follow up

The client came back with pain in his left shoulder whilst the pain in the right shoulder had gone.

posture assessment

  • There is slight atrophy of the left trapezius muscle which is apparent by the prominence of the left medial border of the scapula and also the lowering of the clavicle relative to 6 months ago although this is very slight.
  • the client has a higher hip on the right side, usually this would normally be due to an everted left foot however in this client the right foot is everted.

everted right foot

I checked to see whether the leg length was structural and whether the increase in length was due to a longer tibia or femur

leg length test

  • The right leg looks to be minimally longer due to a longer right femur however this increase does not seem to be sufficient to account for the rise in the right hip when the client is standing.
  • Further examination is required to find what is raising the right hip.