1.5. Shoulder Complaint Flashcards
Why is the shoulder joint so susceptible to injury?
Only joint where tendons (rotator cuff) pass between bones (acromion and humerus)
- 3rd most common MSK complaint
- Prevelance: 16-34% of general population
What type of X-ray view would you get for concern or to best see a shoulder dislocation?
AP view
What type of X-ray view would you get for concern or to best see a shoulder separation?
Axillary view or Scapular “Y” view
What are all the 8 ROM tests for the shoulder?
- Flex/Ext
- ABduct/ADduct
- Internal/External rotation
- Horizontal ABduct/ADduct
What are the 6 speciality tests for the shoulder?
- Painful Arc test (most important/most sensitive)
- Neer impingement sign
- Hawkins impingement sign
- Yerhason sign
- Empty Can test
- Drop Arm test
What is the specialty test for the Acromioclavicular joint/ligament injury?
Cross arm test
What does the painful arc test, test for?
Subacromial impingement and rotator cuff tendon injury
What is the positive and negative likelihood ratios for the positive arc test?
Positive: 3.7 (highest + for all rotator cuff maneuvers)
Negative: 0.36 (lowest - for all rotator cuff maneuvers)
What degrees of ABduction indicate a positive arc test?
Shoulder pain between 60-120 degrees indicates subacromial impingement or rotator cuff disorder
What are traumatic, bone related issues that could present as shoulder pain?
Fractures and dislocation
- Common fx: Clavicle (kids), scapula (BLUNT trauma- coronoid or acromion process), ribs, humerus (most common in elderly)
- Dislocation: glenohumeral
What are traumatic, soft tissue related issues that could present as shoulder pain?
- Myofascial
- Acromial clavicular
- Rotator cuff
What are traumatic, joint (intra-articular) related issues that could present as shoulder pain?
- Cartilage: labral tear
- Hemarthrosis
- Joint capsule
What are atraumatic, intrinsic related issues that could present as shoulder pain?
- overuse injures, shoulder instability
- rotator cuff tendinopathy or impingement syndrome
- subacromial bursitis, inflammatory synovitis
- adhesive capsulitis (frozen shoulder)
- bicipital tendinitis, osteoarthristis
- myofascial pain, septic arthritis, gout
How common is a glenohumeral “shoulder” dislocation?
50% of all major joint dislocations
What are the 3 types of glenohumeral dislocations?
- Anterior: most common (95-97% cases)
- Posterior (2-4%)
- Inferior (0.5%)
How does an acromioclavicular joint injury typically occur?
-Direct trauma to superior or lateral aspect of shoulder (acromion) with arm ADducted (direct blow or falling on shoulder)
What are the types of acromioclavicular injuries?
Many, types 1-6
-Know that is can be an AC or Coracoclavicular L. sprain or ligament rupture
What type of PE would you expect to have with an AC joint injury?
- Tenderness over joint
- Possible deformity
- Pain with ROM, especially ABduction
What type of diagnostic testing would you do for AC joint injury? Specifically
- Single AP x-ray of both AC joints
- US
What are risk factors for rotator cuff injuries?
- rotator cuff impingement
- old age
- repetitive overhead activity in sport or work
What are symptoms of rotator cuff injuries?
- shoulder pain (over lateral deltoid), most prevalent with activity and at night
- weakness
What 4 muscles are involved in the rotator cuff and which one is most commonly injured?
- Supraspinatus Most common
- Infraspinatus
- Teres minor
- Subscapularis
Rotator cuff impingement syndrome
symptoms from compression of rotator cuff tendons and subacromial bursa between greater tubercle and lateral edge of acromion process
Rotator cuff tendon injury
- Sprain or tear (partial or complete)
- End result from chronic subacromial impingement, progressive tendon degeneration, traumatic injury, or combination
