History (shoulder joint)

The history for the shoulder joint should include the following enquiries:

• pain:
  • determining the onset (acute, sub-acute, recurrent), site, nature, exacerbating and relieving factors and any associated symptoms of the pain.
    • may be referred from the cervical spine, myocardium, mediastinum or diaphragm
    • joint pain is felt anterolaterally at the insertion of deltoid from which it may radiate down the arm
    • pain on top of the shoulder may particularly suggest acromioclavicular or cervical spine disorders
  • specifically enquiring about the relationship of the pain to movement. Does it occur at rest?
  • is the shoulder pain nocturnal?
    • while nocturnal pain may be due to difficulty finding a comfortable sleeping position, consider nerve root pain, bony pain or malignancy, particularly if there is a history of cancer and/or systemic symptoms
      
• stiffness
  
• deformity:
  • prominence of the acromioclavicular joint or winging of the scapula
    
• loss of function:
  • what activities are impaired e.g. may be difficulty reaching behind the back, combing the hair or dressing
  • what is the impact on function of the joint? Is the dominant or non-dominant arm affected?

Other issues that should be covered include (1):

• are any other joints affected?
• enquiring about tasks undertaken at work and sporting activities.
• enquiring about systemic symptoms of illness (fever, night sweats, weight loss, generalised joint pains, rash, new respiratory symptoms)
• enquiring about whether there is a past history of shoulder pain or other musculoskeletal problems - what was the response to treatment?
• enquiring about significant co-morbidity (diabetes, stroke, cancer; respiratory, gastrointestinal, or renal disease; ischaemic heart disease)
• checking current drug treatment and adverse drug reactions

Reference:

1. Murphy RJ, Bintcliffe F; Ask the expert: assessment of shoulder pain in primary care. BMJ. 2023 Jul 7;382:1255.