Evaluating Shoulders as an Occupational Therapist

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Evaluating Shoulders Like a Pro: An Occupational Therapist’s Guide

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Hey everyone, Hoang Tran, a licensed occupational therapist, here! Today, we’re diving into the world of shoulder evaluation.

Let’s get visual!

Did you know that just by looking at someone’s posture, you can often see potential issues? In the image above, take a close look at our volunteer’s posture.

Evaluating Shoulders as Occupational Therapist

 

Notice how our volunteer stands? See that slight difference in her shoulders? That’s the superior angle on the left, and the lateral border and inferior angle on the right. The spine runs right down the middle, with the acromion process (that bony point at the top) right beside it.

Want to see a step-by-step demonstration? Check out this video: “How to Evaluate Shoulders as an Occupational Therapist”:

Now, let’s get moving! 

Ask your patient to raise their arms slowly with thumbs up and elbows straight. This helps us assess scapular motion, abduction (how far the shoulder blade can move away from the spine), and the medial border placement (where the inner edge of the shoulder blade sits). We’ll also check for sulcus signs (grooves around the shoulder joint) and elbow movement – because elbows play a role too!

Time to feel the problem! 

We can see some tightness in our volunteer’s right shoulder blade, especially when compared to the left. This limited motion likely points to tightness in the posterior and inferior capsule (the tissues surrounding the shoulder joint). Notice how her shoulder blade lifts away from her ribs when she moves – ideally, it should stay put.

Here’s the detective work: 

By looking at posture and movement, we can start to identify muscle imbalances. In this case, our volunteer’s rhomboids (upper back muscles) seem overworked on the right side, likely compensating for weaker muscles. The serratus anterior (a deep chest muscle) might also be underactive, affecting how the shoulder blade is positioned. Remember those upper, middle, and lower traps we discussed? They might not be pulling their weight either, causing her posture to drift downwards. The pectoralis major and minor (chest muscles) could also be contributing to the downward pull.

Here’s a brief overview of the process of shoulder evaluation

Visual Assessment

  • Posture: A person’s posture can reveal potential issues. Look for asymmetry in the shoulders, rounded shoulders, or excessive hunching.
Image of Person with rounded shoulders
  • Bone Anatomy: Identify landmarks like the superior angle, lateral border, and inferior angle of the scapula (shoulder blade), as well as the acromion process (bony point at the shoulder tip).

Movement Assessment

  • Range of Motion: Ask the patient to raise their arms slowly with thumbs up and elbows straight. This assesses scapular motion, abduction (shoulder blade movement away from the spine), and elbow flexion.
  • Scapular Motion: Observe the gliding movement of the shoulder blade as the arm moves. Look for any limitations or imbalances.

Palpation

  • Muscle Tone: Feel the muscles around the shoulder joint to assess for tightness or weakness.

The takeaway 

Evaluating shoulders involves looking at the bigger picture. We assess scapular motion, the humerus bone (upper arm bone), and the muscles in the front and back. It’s all about understanding how the posterior muscles, rotator cuff muscles, and anterior muscles work together for optimal shoulder health.

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Author:

Hoang Tran

“I help Occupational Therapists develop their skills and grow their confidence in Hand Therapy. No matter where you are on your journey, build a happy and fulfilling career of your dreams. I’ll help you.”