Approach to Shoulder Pain Flashcards
Most common extrinsic cause of shoulder apin and others
Cervical spine abnormalities
Cardiac, lung/pleura, intraabdominal, neurologic
Atrophy of muscles above and below scap spine
Superior porminance of distal clavical
Medial porm of SC joint
Chornic supraspinatus - above
Chronic infraspinatus - below
Dislocation
Dislocation
Tenderness over
Clavicle AC joint Inferior to AC joint Bicipital groove Sternoclavicular
Fracture
Separation or arthritis
Aubacromial burisits
Bicipital tendinopathy or tear
Fracture
Active vs. passive ROM
Active only - RC tenidnopathy, biceps tendinopathy, or subacromial burisits
Both - glenohumeroal joint (RA or frozen) or AC sep/OA
Abduction between 60 and 120 (painful arc)
Abduction between 120 and 180
Ext rotation pain
Int rotation pain
RC dz
AC joint
Teres minor or infraspinatus
Subscapularis
Jobe test
PLace arm in 90 of abduction, 30 degrees of forward flexion and internal rotation..ask to resist dowward
Pain or weakness is RC tendinopathy or tear (supraspinatus)
Neer impingeent sign
One hand stabilizes scap while other flexes with patient’s straight arm
Pain suggests RC tendinopathy or impingmeent syndrome
Hawkins Kennedy test
One hand stabilizes scap while other hand internally roates the part flexed 90 degrees at elbow
Pain or discomfort is RC tenidnopathy or impingement syndrome
RC injury
Traumatic, overuse, or combo
Most common supraspinatus
Shoulder weakness and anterolateral pain worse at night and with overhead motion
Pain between 60 and 120 abduction and inability to abduct beyond 90
Weakness in empty can abduction
Labral tear
Superior labrum anterior to posterior tear is common if throwing
Usually acute from falling on outstreatched or direct blow
Decline in throwing function or anterior pain in shoulder
AC separation
Direct trauam to superior or laterla shoulder or flal on outstretched
Rupture the AC ligament
Pain loalized worse with apssive adduction across the body
X-ray will confirm
Biceps tendon tear
Acute onset after lifting
Hx of anterior shoulder pain aggravated by carryning or overhead reaching
Tenderess of bicipital groove, lump above the antecubital fossa or weakness of elbow flexion
GH disclocation
Anterior dislocation from abducted, externally roated and extedned arm (blocking a shot)
Holds arm abducted and extenrally roates and resists GH movement
Loss of normal shoulder appearance with prominent acrominon
Axillary nerve injured so loss of sensation just distal to deltoid
Transient brachial plexopathy
Actue trauamtic contact ot neck or aneterior shoulder
Sfeeling in supraclvicular area raditating dwon arm in cricumferential, non dr mpattern
Motor deficits of C5-C6 (deltoid and supraspinatus)…weakness of abduction and/or empty can shoulder abduction
Clavicle fracture
Fall onto shoulder
Middle thrid of the bone…followed by distal
Localized pain over clavicle worse with arm movement
May have ecchymosis or hematoma
Point tenderenss/crepitus
Most nondisplaced tx with immobilization
RC tendinopathy
Older adolescents and young adults in throwing sports
impingement narrowing between acromon and RC tendons…acromion rubs against tendons and subacromial bursa
Most commonly supraspinatus
Shoulder weakness and anterolateral hsoulder pain worse at night and with overhead
Pain with active abduction between 60 and 120 and pain with empty can abduction
Proximal humeral epiphysiolysis
Little lead shoulder between 10 and 15
Torque of humerous leadsto microtrauam and irritatin of proximal humeral physis…widing of the physis
Worsening lateral shoulder pain
GH instability
Young women with poor muscular development or atheletes iwht constant overhead throwing
Giving way or looseness of the joint
Anterior instability and wors ewith shoulder abduction and rotation
Exam may show increased ROM of the GH joint and patient apprehension with extreme abduction and extenral rotation
Labral tear
SLAP is most common
Clikc when parm placed in throwing position
Click on any manuever that compresses and rotates the head into the glenoid
MRI needed
Biceps tendinopathy
Uncmmon by inteself but accompanies GH instability in younger
Anteriro shoulder radiating to distal biceps with tenderness of bicipital groove
RC injury older
Stillsame sx but may have acute onset
AC joint separation older
Same as in younger
Biceps tendon tear older
Degerative tendinosis plus actue injry
Most have hx of anterior shoulder pain
Sudden painful extension of a flexed elbow after full contraction
Pseudogout
Think sudden onset of shouder pain and another joint
Adhesive capsulitis
Gradual development of limited active and passive motion
Diabetes, thyroid, prolonged immobilization ad shoulder injuries
Inflammation of joint capsule followed by fibrosis of synovial lining
40-70 y/o
Initial inflam phase with diffuse pain worse at night and with sitffnesss
Fibrotic second phase with loss of motion 4-12 months
On exam, patients have limited ROM in multiple planes
PT and intra-artc GCs
RC tendinopathy
Most common cause of recurrent pain in older adults
Looks like a tear
Subacromial burisits
Supraspinatus tendon passes through space between acromion and subacromial bursa…inflammation of bursa rubs tendon against acromion and subacromial bursa
identical to RC tendinopathy
Ac joint OA
Pain localized worse with passive adduction across the body
Xpray can confirm with typical OA findings
RA
Symmetric hsoulder involement with small joints of hands
PMR
Over 50
Symmetric pain with lots of morning stifness
Elevated ESR and low-dose GC response
