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Evaluation and Treatment of the Shoulder Complex: Summary
Shoulder Complex Red Flags Red Flag
Indication
Constant pain/ unchanged by movement
Organ referral pain • Left shoulder = spleen • Right shoulder = liver and/or gallbladder (typically worsens after meals, especially meals that are high in fat)
• History of cancer = primary predictor of relapse • Pain unchanged with movement Endocrine dysfunction • Hair loss • Head intolerance • Posterior shoulder pain Diagnoses of endocrine dysfunction • Hyperthyroidism o Heat intolerance o Loss of hair o Pain to posterior shoulder complex • Diabetes mellitus (tpye II; organ: pancreas) o Polyuria o Polydypsia o Pain at thoracic spine, scapula bilaterally,
History of cancer
Unexplained weight loss
• Shoulder pain in the form of mononucleosis (left shoulder) • Pancreatitis (thoracic spine, bilateral scapulae, and bilateral shoulder complex) • Hepatis (liver inflammation): Pain to right shoulder • Cancer • Bone pathology (e.g ., stress fracture; athletes—baseball, softball)
Fever
Pain at night
Shoulder Complex: Components of Examination Posture
The neurofascial system is altered by injury. An injury creates faulty sensory information because of the change of tone in the injured muscle. Change in tone can change proprioception and over time can create movement dysfunction. Over time, the brain will recognize the abnormal movement pattern and will begin to recognize it as normal. Typically, when an individual performs an activity for greater than 6 weeks, the brain internalizes it as habit or normal function. Neurological research has shown that in as little as 7 to 10 days, an abnormal movement pattern can be recognized as normal by the brain.
Posture can give basic information about muscle balance and imbalance . If a patient presents with shoulder internal rotation and scapular protraction muscles, an anterior aspect is tighter compared to a posterior aspect, and posterior muscles will be weaker compared to anterior muscles. Research shows that posture is an outward expression of mental status.
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