A shoulder screen can be done in a minute. Looking for asymmetry of motion or a scapula-humeral dyskinesia is the foundation of any evaluation and restoring normal mechanics is the goal of any treatment. This video was shot during a teaching session at The Family Practice. Thank you Paul Safford PAC for lending us your shoulder and thank you to the team at TFP for engaging in this short lecture.

Quick Assessment of the shoulder for any problem has one primary goal. We want to answer the question -  "is there a shoulder dyskinesia?"

A scapula-humeral dyskinesia is where the humerus and scapula fail to work in their efficient and normal tracking pattern. Have your patient raise their arms to the ceiling. Look for asymmetry. Is there a difference in spacing between the arm and the head and neck? Feel the scapular inferior angles and feel for the medial scapular borders. Are the shoulder blades in the same position?

Is there a Shoulder Dyskinesia?

Notice that the right shoulder has increased scapular rotation and a loss of spacing between the arm and the head and neck.

A second test to check motion as well as symmetry is the 'Apley Scratch Test' or shoulder internal rotation. A loss of shoulder internal rotation is a great predictor of a shoulder dyskinesia or problem.

Look for a lack of should blade position as well as limited height of the hand up the back.

While there are many tests that can be done to assess the shoulder and determine the tissue that is injured looking for abnormal shoulder mechanics is the most important. This also becomes the goal for treatment. Any treatment plan should have a focus on restoring normal artho-kinematics or tracking of the shoulder. A chronic shoulder dyskinesia will cause further and progressive injury as continued shoulder use is attempted. Starting with an exercise program does not make sense in this situation and is a reason while therapy programs can fail.

The goal of every treatment is to restore normal shoulder motion.

Treatment should begin with restoring normal mobility prior to any strengthening. Too often treatment approaches focus on weight training that can further hurt the shoulder. Stretching needs to be targeted and assessed to see if the shoulder mobility is being restored. Most stretches are not specific and do not target joint motion effectively. Sometimes increased tension or strain can occur with stretching. How you know treatment is working? The shoulder problem does not return.

Do not start a shoulder treatment program with strengthening exercises!

• Treat the underlying joint dysfunction or loss of motion
• Treat the muscle imbalances and trigger points
• Restore normal tracking and shoulder motion
• Strengthening programs can be introduced at this point
• Prevent further injury through behavioral and habit changes

Diagnostic ultrasound

Screening the shoulder can include a diagnostic ultrasound. This is an incredible tool to assess for rotator cuff tears, inflammation and swelling, bursal swelling, and even cartilage degenerative changes. Cornerstone Physical Therapy routinely screens shoulders with diagnostic ultrasound. This helps guide treatment and speeds up decision making on when to refer to different specialists or further imaging such as an MRI. It is safe, fast, and there is no radiation.