The injured shoulder. Primary care assessment

Shoulder problems are the second most common orthopedic complaint in primary care medicine. The range of motion, ligamentous and muscular support, and central location of the shoulder are key factors for the successful performance of persons at work or on the playing field. These special attributes also contribute to injury and to difficulty in assessing the painful shoulder. An understanding of the pertinent anatomic structures, the differential diagnosis of shoulder pain (intrinsic and referred pains), and a systematic approach to the evaluation including a complete history and physical examination are necessary in this assessment. Adequate examination consists of inspection, muscle strength and range-of-motion testing, palpation, and neurologic testing of the shoulder, neck, and elbow followed by special tests to detect impingement, instability, or tendinosis. This basic assessment is augmented by the proper use of radiographs, arthrography, computed tomography, ultrasonography, and magnetic resonance imaging. An adequate database and proper assessment of the injured shoulder allow the primary care physician to make a pathoanatomic diagnosis and formulate an appropriate treatment plan and make appropriate use of orthopedic consultants.