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A physical examination should also include screening for physical abnormalities—swelling, shoulder pain deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved. This is when a Prolotherapist and his ability to reproduce pain by touching is invaluable.

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Shoulder – Range of Motion Abduction: 0° to 160 – 180° observe for "painful arc" at shoulder level and/or "shrugging" / "shoulder hiking" Forward Flexion: 0° to 160 – 180° Adduction at side: 0 – 30° cross-body: at minimum should be able to cup hand on opposite shoulder Extension: 0° …

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A little higher towards the superior border will be the levator scapula, which are often very tense and tender. Once the scapula is able to slide side to side freely, it is easier to work on the muscles that attach at the posterior portion of the shoulder girdle that are accessible only from underarm area, specifically, the subscapularis, teres ...

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