It is necessary to examine both shoulders, disrobed and cervical and thoracic spine.
The patient to be examined, just visit either for pain or because his shoulder dislocates.
I) The patient consults for pain.
The first question I ask the patient: "Show me where your pains are? "
o Pain on the side of the arm: it is probably a lesion of the tendons of the rotator cuff.
o Pain on the lateral side of the arm,extending to the neckand chest.
If the cardiac problem was eliminated, it is probably a calcification of the shoulder. Imaging clarifies the diagnosis.
o Pain on the front side of the arm
It is probably an inflammation of the long head of biceps, caused by repetitive movements(computer mouse, gardening, etc....)
o Pain on acronomio-clavicular joint
It may be the consequences of a simple fallor while playing sports(martial arts, ice hockey, rugby, skiing, horse riding, cycling), especially if there is anassociated strain. Imaging clarifies the diagnosis.
o Localized pain in the shoulder and associated with crunches every time the patient moves his arm.
o Pain from the neck and down the arm to the fingers.
II) The patient consults because his shoulder was dislocated several times.
o The first thing I look at clinical examination is the existence of a constitutional hyperligamentous laxity: The patient's joints are too flexible, and we look for a history of recurrent sprains of the ankleorknee pain. This hyperligamentous laxity, resulting, at the shoulders, by excessive external rotation exceeding 85 degrees (Photo10). Hyperligamentous laxity aggravates shoulder instability.
o Clinical examination research cautiously an apprehension of the patient, the shoulder is positioned in dislocation side, with an elevation process of the armabove the horizontal and it is associated with an external rotation (position of the handball shooting).
o Imaging clarifies the diagnosis.