Clinical evaluation of the shoulder.

Shoulder pain is an exceptionally common problem in physiatric practice. Evaluation and management of patients with shoulder dysfunction can challenge even the most experienced practitioner. The complexity and inherent instability of the shoulder lead to functional overload of various bony and soft tissues within the joint complex and adjacent structures.Additionally, shoulder pain may be the initial manifestation of a potentially serious condition. Consequently, a detailed and systematic approach to the evaluation of a patient with shoulder pain is crucial in establishing a complete and accurate diagnosis. A skillfully performed history and physical examination allows identification of specific tissue pain generators and biomechanical dysfunction throughout the kinetic chain. Only after these elements have been defined clearly can an appropriate rehabilitation program be de-signed. A thorough clinical assessment also can aid in the detection of serious diseases that masquerade as shoulder pain. An effective clinical evaluation enhances the quality and cost-effectiveness of care and facilitates a successful outcome in most cases.