Part of Lesson Plan: Shoulder Injury Assessment by Fidencio Cuevas

Activity Overview / Details

At this time I hand out the H.O.P.S. shoulder sheet and begin to model how to perform a shoulder injury evaluation. I say,

" We will use H.O.P.S. to assess shoulder injuries. The sheet you just got is a script that leads you through an injury assessment for the shoulder. In history we ask to obtain permission from athlete to assist, expose injury for assessment, primary complaint, what happened?, How did it happen? (mechanism of injury), where does it hurt? (point to it with one finger), what type of pain is it? (dull, aching, sharp shooting, tingling), any radiating pain?, has it ever happened before? (if so, how long ago), did it just happen? (acute onset) Has it been going on for a while? (chronic onset), level of pain? 1-10 (10 being worst), what type of training have you been doing?, does it feel loose?, any medications?, any restrictions/limitations? (what they can/can’t do), did you feel anything pop or snap?,did you feel anything locking, catching or giving out?"

" We want to make sure the observations we do are bilateral and observe for swelling(ant/post., med/lat, joint line), deformities (deltoids, clavicle, AC/SC), discoloration (shoulder, forearm, elbow), abrasions/lacerations, contours of shoulder (ant/post.,AC/SC),carrying angle, athlete’s expressions,, normal or drop shoulder"

" When we palplate we are checking for point tenderness and to rule out possible fractures in bony and soft tissues and we palpate the sternoclavicular joint, clavicle, acromioclavicular joint, acromion process, coracoid process, spine of scapula, medial border of scapula, inferior angle of scapula, humerus, glenohumoral joint and for the soft tissue the deltoids, rhomboids,trapezius, supraspinatus, infraspinatus, teres minor, subscapularis"

I demonstrate the following on a teacher's assistant if one is available, if not I call up a student as a model

" For special test we are checking for pain and strength and we perform the Apley scratch test, passive active and resistive range of motion (int./ext. rotation, flexion/extension), Neurological we check BILATERAL!!! for motor functions from looking at C3 & C4 (trapezius – shrugging, C5 & C6 (biceps/pec. maj/ delt – arm curl, shoulder abduction), C7 & C8 (tris/lats – arm/shoulder extension)   and then use Stress tests such as Apprehension  test (anterior joint instability), Piano key (acromioclavicular sprain), Empty can (strain to supraspinatus), Drop arm ( stain to supraspinatus and deltoids), Hawkins/Kennedy test ( brachial plexus impingement)"