Clinical Assessment of Chronic Painful Shoulder

Manipulation and physical examination of the shoulder in the early post-traumatic period is often difficult and hazardous, as it may lead to dislocation or displacement of an underlying sub-luxation or non-displaced fracture. However, it can be performed at distance from the initial trauma, and after ruling out any fracture and or dislocation. The first step in the assessment is to obtain the patient’s history and details of the trauma, including the circumstances of occurrence (such as road traffic accident, sports, or domestic incidents), the type of trauma (direct or indirect), the character and severity of pain, and the degree of functional disability. The second step involves a careful inspection followed by the evaluation of active and passive shoulder mobility. Finally, provocative and dynamic maneuvers are performed to assess the shoulder stability and the condition of the rotator cuff tendons.