Case 1- shoulder problems Flashcards
Painful arc sign
Pain with abduction> 90 degrees
tests rotator cuff pathology
Neer test
tests Shoulder impingement
passive flexion of glenohumeral joint
Hawkins Kennedy Test
tests Shoulder impingement
elbow flexed 90. internal shoulder rotation. pain= positive test
Jobe’s test
Supraspinatus
adduct arm while patient resists
Testing external rotation
infraspinatus/ t.minor
Gerber test
internal rotation for subscapularis.. Hand behind back and push back/up (high five?)
Shoulder pain first step
traumatic or not? If yes, get x-rays
X-rays don’t show problem
look for intrinsic injury of soft tissue.
Glenohumeral= rotator cuff, capsulitis, impingement, labral tear
ExtraGH= bicep tendon (itis or rupture), AC arthritis, subscap bursitis, clavicle ostolysis
No trauma?
Intrinsic or extrinsic cause
look for acute arthritis
Scan for boney things
x-ray, ct
soft tissue scan
MRI
Ultrasound
cheap
arthrocentesis
do it if person might have arthritis
Acute arthritis can be from?
Arthrocentesis to check for:
gout (uric acid), bacteria (high WBC), pseudogout (Calcium PP), rheumatoid/osteoarthritis
diabetics have increased risk for?
frozen shoulder (adhesive capsulitis). Pain and stiffness in ALL ranges of motion. Hence FROZEN.
Bursitis
can be caused by arthritis
Myofascial pain
tissue tenderness of shoulder and chest? WTF?
Bicipital groove pain/tenderness
bicipital tendonitis…duh. why is this on a slide?
Extrinsic shoulder pain causes
Neuro -nerve root compression, supraspinatus nerve, plexus, herpes, abdominal/hepatobiliary (dermatome shit).
Diaphragm- spleen, ectopic pregnancy, etc.
CV- MI, axillary vein thrombosis (somehow I think this is SUPER rare..), thoracic outlet syndrom
Thoracic- upper lobe pneumonia, apical lung tumor, pulm embolis
Treatment for this dude?
pendulum exercise, surgery had it been a complete tear. rest and drugs.
Algorithm for rotator cuff tendinopathy
- physical, history tells you
- Yes it’s a rotator cuff pathology–how serious?
- significant tear= ortho referral, minor- manage
- Minor management didn’t help, do more tests and find out 1) he needs ortho consult, 2) it’s what we though and the persons a whimp or 3) it’s the wrong diagnosis (obv treat new issue)
- person is a whimp, change therapy accordingly
- still a whimp? send to ortho bc you don’t wanna deal with him anymore.
