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Evaluation and Treatment of the Shoulder Complex: Summary
History and Medical Red Flags Pain changing with movement typically indicates musculoskeletal pain. If any red flag is identified, you should refer the patient to their primary care provider before initiating physical therapy.
Compression of part of the anterior neurovascular bundle can be caused by tightness of the pectoralis minor and major, as well as biceps brachii. Compression of part of posterior neurovascular bundle can be caused by tightness of the teres major, teres minor, and triceps brachii.
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
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