Case 1- shoulder problems

Question 1

Painful arc sign

Answer 1

Pain with abduction> 90 degrees

tests rotator cuff pathology

Question 2

Neer test

Answer 2

tests Shoulder impingement

passive flexion of glenohumeral joint

Question 3

Hawkins Kennedy Test

Answer 3

tests Shoulder impingement

elbow flexed 90. internal shoulder rotation. pain= positive test

Question 4

Jobe’s test

Answer 4

Supraspinatus

adduct arm while patient resists

Question 5

Testing external rotation

Answer 5

infraspinatus/ t.minor

Question 6

Gerber test

Answer 6

internal rotation for subscapularis.. Hand behind back and push back/up (high five?)

Question 7

Shoulder pain first step

Answer 7

traumatic or not? If yes, get x-rays

Question 8

X-rays don’t show problem

Answer 8

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

Question 9

No trauma?

Answer 9

Intrinsic or extrinsic cause

look for acute arthritis

Question 10

Scan for boney things

Answer 10

x-ray, ct

Question 11

soft tissue scan

Answer 11

MRI

Question 12

Ultrasound

Answer 12

cheap

Question 13

arthrocentesis

Answer 13

do it if person might have arthritis

Question 14

Acute arthritis can be from?

Answer 14

Arthrocentesis to check for:

gout (uric acid), bacteria (high WBC), pseudogout (Calcium PP), rheumatoid/osteoarthritis

Question 15

diabetics have increased risk for?

Answer 15

frozen shoulder (adhesive capsulitis). Pain and stiffness in ALL ranges of motion. Hence FROZEN.

Question 16

Bursitis

Answer 16

can be caused by arthritis

Question 17

Myofascial pain

Answer 17

tissue tenderness of shoulder and chest? WTF?

Question 18

Bicipital groove pain/tenderness

Answer 18

bicipital tendonitis…duh. why is this on a slide?

Question 19

Extrinsic shoulder pain causes

Answer 19

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

Question 20

Treatment for this dude?

Answer 20

pendulum exercise, surgery had it been a complete tear. rest and drugs.

Question 21

Algorithm for rotator cuff tendinopathy

Answer 21

1. physical, history tells you
2. Yes it’s a rotator cuff pathology–how serious?
3. significant tear= ortho referral, minor- manage
4. 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)
5. person is a whimp, change therapy accordingly
6. still a whimp? send to ortho bc you don’t wanna deal with him anymore.