2.  Anatomy  History  Observation  Palpation  Neurological exam  Circulatory exam

3.  Clavicle  Scapula  Humerus  Articulations: ◦ Sternoclavicular joint ◦ Acromioclavicular joint ◦ Glenohumeral joint

4.  Ligaments ◦ AC ◦ Glenohumeral ligaments/joint capsule  Labrum

5.  Musculature ◦ “Rotator cuff”  Subscapularis  Supraspinatus  Infraspinatus  Teres Minor

6.  Musculature ◦ Pectoralis major ◦ Deltoid ◦ Trapezius

7.  Subacromial bursa

8. Mechanism of injury: 1. Describe the mechanism of injury 2. Was there a direct blow? 3. What was the angle of impact? 4. What was the position of the arm at impact? 5. Did you hear or feel anything at the time of injury? 6. Was the arm forced beyond normal limits? 7. Did the injury occur due to forced muscular contractions?

9. Pain/Symptoms: 8. Demonstrate what movements aggravate pain? 9. What activities increase pain? 10. Describe the onset of symptoms 11. Describe symptoms? 12. Sharp or dull? 13. Constant or intermittent? 14. Localized or diffuse? 15. Aggravated by movement? 16. Relieved by rest?

10. Pain/Symptoms (cont.): 17. Where is the pain? 18. Do you feel pain radiating down the arm? 19. Is there any numbness, burning, tingling or weakness in the upper extremity? 20. Do you feel tightness, tension, locking, swelling, or crepitation?

11. Previous injuries: 21. Have you had a previous injury? 22. Are the symptoms you are experiencing currently similar to those associated with the previous injury (‘Your’ pain)? 23. What treatment was used? 24. What rehabilitation was used? 25. Were you fully recovered?

12. 1. Swelling 2. Skin color 3. Signs of trauma 4. Skin temperature 5. Sprengel’s deformity 6. Atrophy 7. Abnormal position

13. 1. Swelling 2. Skin color 3. Signs of trauma 4. Skin temperature 5. Sprengel’s deformity 6. Atrophy 7. Abnormal position

14. 8. Arm hanging limp 9. Appear to be in pain 10. Compare 11. Symmetry 12. Deformities 13. Muscle spasm 14. Holding or supporting arm 15. Moving or using involved extremity 16. Overall position, posture, and alignment

15. 1. Acromion process 2. Clavicle 3. Acromio-Clavicular (AC) joint 4. Sterno-Clavicular (SC) joint 5. Coraco-Clavicular (CC) joint 6. Coracoid process 7. Axilla

16. 8. Head of humerus 9. Greater tuberosity 10. Lesser tuberosity 11. Bicepital groove 12. Deltoid tuberosity 13. Humerus 14. Scapula

17.  Sensory dermatomes  C2-C3: Occipital area and angle of jaw  C4: Supraclavicular area  Axillary Nerve Patch: Lateral aspect of shoulder  C5: Lateral upper arm  C6: Lateral forearm, thumb, and index finger  C7: Middle finger and palmar aspect of hand  C8: Small finger, ring finger, and medial portion of palmar surface  T1: Medial side of forearm and elbow  T2: Medial aspect of upper arm  T3: Medial aspect of upper arm

18.  C1-C2: Neck flexion  C1-C2: Neck extension  C3: Neck lateral flexion  C4: Shoulder elevation  C5: Shoulder abduction and external rotation  C6: Elbow flexion and wrist extension  C7: Elbow extension and wrist flexion  C8: Thumb abduction and ulnar deviation  T1: Finger approximation

19.  Biceps (C5-C6)  Supinator (C5-C6)  Triceps (C7-C8)

23.  Carotid  Brachial  Radial

24.  Muscular anatomy  Special tests