Approach To Shoulder Complaint

Question 1

Why is the shoulder joint unique?

Answer 1

The only joint in the human body where tendons (rotator cuff) pass between bones (acromion and humerus)
Allows for greater flexibility but also susceptibility to injury

Question 2

What are some complaint specific factors you want to obtain for the HPI?

Answer 2

Traumatic or atraumatic, mechanism, can they bear weight or use the extremity? And last food intake

Question 3

What is the most sensitive indicators of joint disease?

Answer 3

Evaluation of ROM

Question 4

Which tests test for subacromial impingement and rotator cuff tendon injury?

Answer 4

Painful arc test, neer impingement sign, Hawkins impingement sign, yergason sign, empty can test, drop arm test

Question 5

Which test tests for acromioclavicular joint/ligament injury?

Answer 5

Cross arm test

Question 6

Which tests has the highest positive LR of all rotator cuff maneuvers and the lowest negative LR of all rotator cuff maneuvers?

Answer 6

Painful arc test (positive if pain from 60-120 degrees of movement)

Question 7

What are the UE reflexes?

Answer 7

Triceps (C6-7)
Biceps (C5-6)
Brachioradialis (C5-6)

Question 8

You should always check pulses and/or capillary refill distal to what?

Answer 8

Site of injury

Question 9

What are some traumatic causes of shoulder pain?

Answer 9

Bone (fractures, dislocations)
Soft tissue injuries (ligamentous, tendon and myofascial injuries)
Joint cartilage or capsule (labral tear)

Question 10

What are the three types of glenohumeral (shoulder) dislocation?

Answer 10

Anterior (most common), posterior and inferior dislocations

Question 11

Describe acromioclavicular joint injuries

Answer 11

Usually occurs from direct trauma to the superior or lateral aspect of the shoulder (acromion) with the arm adducted such as a direct blow or falling onto the shoulder

Question 12

What will be seen during the PE if a pt has an AC joint injury?

Answer 12

Tenderness directly over the AC joint, possibly associated with deformity, pain with ROM (especially abduction)

Question 13

What tendon is the most often injured in a rotator cuff injury?

Answer 13

Supraspinatus

Question 14

What will be seen on PE when a pt has a rotator cuff injury?

Answer 14

Tenderness over the affected musculature or focal subacromial tenderness at the lateral or posterior-lateral border of the acromion

Question 15

What are some atrauamatic causes of shoulder pain?

Answer 15

Extrinsic (referred no shoulder pathology at all

Intrinsic (shoulder as a whole)

Question 16

What are neurologic/extrinsic causes of shoulder pain?

Answer 16

Cervical radiculopathy, brachial plexus lesions, herpes zoster, spinal cord lesion, cervical spine DJD and thoracic outlet syndrome

Question 17

What are the most common causes of acute shoulder pain?

Answer 17

Rotator cuff injury, fracture/dislocation, AC injury and myofascial injury

Question 18

What are the most common causes to chronic shoulder pain?

Answer 18

Rotator cuff disorders, adhesive capsulitis, shoulder instability and shoulder arthritis
Life threatening situations like SA or referred pain caused by acute MI, intraperitoneal hemorrhage, lungs pathology

Question 19

What three joints are involved with scapular motion?

Answer 19

AC joint, sternoclavicular joint and scapular thoracic joint (not a true joint)

Question 20

What does scapula motion require?

Answer 20

Clavicular motion (linkage/coupled motion) 
Clavicle must articulate with acromioclavicular and sternoclavicular joints to do so 
Acts like a seesaw

Question 21

Describe clavicle coupled motion (glide motion) during scapula depression

Answer 21

Distal clavicle (AC joint) -> inferior glide 
Proximal clavicle (SC joint) -> superior glide

Question 22

GH joint external rotation also causes what?

Answer 22

Clavicle externa rotation at AC joint

And vice versa