1. EVALUATION OF THE PAINFULL SHOULDER NICK KILMER, MD Primary Care Sports Medicine, University of Rochester RRFMC, OCTOBER 1, 2011 For unabridged PowerPoint, please contact kelly@nysafp.org

2. EVALUATION OF THE PAINFULL SHOULDER OUTLINE: ANATOMY: SURFACE AND INTERNAL HISTORY: RED FLAGS PHYSICAL EXAM: OBSERVATION, RANGE OF MOTION, SPECIAL TESTS, PALPATION

3. SHOULDER EVALUATION SURFACE ANATOMY: 4 JOINTS: STERNOCLAVICULAR ACROMIOCLAVICULAR GLENOHUMORAL SCAPULOTHORACIC

4. SHOULDER EVALUATION ANATOMY: INTERNAL MUSCLES LIGAMENTS CARTILAGE BONES

5. SHOULDER EVALUATION HISTORY: CC: PAIN, SWELLING, DECREASED ROM ACUTE (MECHANISM?)VS CHRONIC NV SYMPTOMS MECHANICAL SX’S A.M.P.L.E. HX “RED FLAGS” ANGINAL SYMPTOMS CONSTITUTIONAL SX’S NIGHTTIME SX’S MULTIPLE JOINTS NV SYMPTOMS

6. SHOULDER EVALUATION EXAM: OBSERVATION (SWELLING, ECCHYMOSIS, DEFORMITY), ROM- ACTIVE, PASSIVE, STRENGTH, SPECIAL TESTS, PALPATION, NV JOINT ABOVE, JOINT BELOW

7. SHOULDER EVALUATION EBM: ROTATOR CUFF TENDONITIS WITHOUT TEAR: AVOID IRRITATING ACTIVITY NSAIDS IF TOLERATED EXERCISES FOR ROM EXERCISES FOR STRENGTH SOURCE: AAOS AT GUIDELINES.GOV

8. SHOULDER EVALUATION ROTATOR CUFF TEAR: AGE> 40 50/50 TRAUMATIC/ ATRAUMATIC NIGHT PAIN WEAK EXTERNAL ROTATION LIDOCAINE TEST

9. SHOULDER EVALUATION EBM: GLENOHUMERAL OA: ACTIVITY MODIFICATION NSAIDS IF TOLERATED PHYSICAL THERAPY FOR MOTION AND STRENGTH IF TOLERATED SOURCE: AAOS AT GUIDELINES.GOV

10. SHOULDER EVALUATION PALPATION: BONY: SC, CLAVICAL, AC, ACROMION, SCAPULAR SPINE, CORACOID PALPATION: SOFT TISSUES: DELTOID, TRAPEZIUS, BICEPSTENDON

11. SHOULDER EVALUATION EBM: CHRONIC SHOULDER PAIN PATIENTS WITH GREATER THAN THREE MONTHS OF ATRAUMATIC SHOULDER PAIN SHOULD UNDERGO AP INTERNAL AND EXTERNAL ROTATION RADIOGRAPHS SOURCE: ACR AT ACR.ORG

12. SHOULDER EVALUATION CONCLUSIONS: SHOULDER PROBLEMS COMMONLY ENCOUNTERED IN PC OFFICE PRACTICE MOST CAN INITIALLY BE MANAGED WITHOUT REFERAL NSAIDS, PT, IMAGING