Summary

So the aim of the assessment is always to decide whether we have the means and capacity to deal with the clients who come to us. This can be done through guided questions in the anamnesis, through physical examinations as deemed necessary following examination and palpation. Functional and specific tests can be of great help in this. Symptoms around the shoulder joint are often related to abnormal functioning of the shoulder girdle or abnormalities of the cervical and/or dorsal spine. It is up to the physiotherapist to decide which of the many tests to use and, in the case of a positive test, to confirm the test with further tests from a similar range. It is worth ruling out or just identifying a problem area and starting from there. This is often not easy, however, because there are no big, clear pointers. It should be remembered that tests should never look at a single structure, a wide scope and complexity is needed to get the right result. To summarise, let us now look again at what to look for in the decision-making process of a person with shoulder symptoms. 

1. Ask about the present complaints, ask about any additional problems that may require the involvement of other professionals in terms of physiotherapy. 

2. Examine and palpate the shoulder-shoulder-bone-neck complex, looking for abnormalities. Try to identify any deviations or asymmetry of the body parts in relation to the reference points. You can also use the application presented here. 

3. Measure range of motion or lack thereof using conventional methods (goniometer, inclinometer), or, in case of minor deficits, using functional tests or special tests or during the performance of these tests (e.g. painful face test).  

4. Carry out muscle strength testing using conventional methods e.g. British Medical Research Council (MRC) muscle grading or tests that provide information on muscle strength. E.g.: Dynamic Rotator Stability Test 

5. Then, based on the results (information you have heard, seen, experienced), carry out the tests you think are necessary. Remember, a single test does not confirm a certain pathological background (specificity), but, taking into account the correlations, they provide a very good basis for a functional diagnosis.  6. Finally, it should be remembered that the relationship and interaction of each movement segment must also be taken into account. To this end, the examination of the shoulder girdle, the cervical and thoracic segments can and should be part of the examination of the shoulder joint. In the longer term, the results of treatment can only be maintained if quality movements are performed, based on good posture and dynamic stability. The latter includes stability provided by the muscles in both open and closed kinematic chain movements.