Common Shoulder Problems Flashcards
Second highest musculoskeletal expenditure behind low back and neck pain
Shoulder pain
Most common diagnoses of shoulder pain
Rotator cuff and impingement
Red flags related to the shoulder
Cancer Cardiovascular Gastrointestinal Infection Trauma
Examples of cancer that can refer to the shoulder
Pancoast tumor
Osteosarcoma
Liver cancer
Examples of cardiovascular conditions that can refer to the shoulder
Myocardial infarction
Pulmonary embolism
Examples of gastrointestinal conditions that can refer to the shoulder
GERD
Indigestion
Hepatitis
Examples of infections that can refer to the shoulder
Osteomyelitis
Spinal abscess
Syringomyelia
Examples of trauma that can refer to the shoulder
Fracture
Dislocation
Competent management of shoulder disorders requires…
a moderate skillset in CT management, differential diagnosis, and regional interdependence
What pathoanatomic diagnoses fit under the subacromial pain syndrome umbrella of the level 2 pathoanatomic diagnoses?
Subacromial impingement
Rotator cuff tendinopathy and tears
Bicipital tendinopathy
SA bursitis, secondary instability, and SLAP
Level 2 Pathoanatomic Diagnoses
Subacromial pain syndrome
Adhesive capsulitis
Glenohumeral instability
Other
SAIS is characterized by…
compromise of structures under the acromion (biceps tendon, supraspinatus, or bursae)
What problems do people with intrinsic caused SAIS have?
Problems with components within the subacromial space
Description and characteristics of intrinsic caused SAIS
Described as an outlet problem and is often characterized by a painful arc of motion
What problems do patients with extrinsic caused SAIS have?
Problems with structures bordering the space
What population is typical of extrinsic caused SAIS?
Typically younger, less than 35 years old who participates in repetitive motions (throwers, swimmers)
What can cause SAIS overall?
Glenohumeral mechanics
Scapulothoracic mechanics
Degeneration/inflammation of tendons or bursa
Acromion morphology
Postural dysfunctions
Weakness
Capsular dysfunction (laxity or tightness)
Risk factors for SAIS
Age Muscle imbalances Capsular tightness Repetitive overhead activities Structural asymmetry Position of the humerus at rest Impaired scapular kinematics Trauma to shoulder/arm
Historical factors commonly seen in those with primary SAIS
Pain at night
Pain with overhead activities
Complaints of stiffness
Test-item cluster for primary SAIS
Hawkins-Kennedy
Painful arc Sign
Infraspinatus muscle test
Historical factors commonly seen in those with secondary SAIS
Young History of instability Pain with overhead activities Hypermobility Overhead athlete
Objective findings commonly seen in those with secondary SAIS
Observation of scapular dyskinesis
Weakness of scapular stabilizers
Positive instability tests
Rotator cuff tendinitis is more common in…
younger people with repetitive activity and stresses to the tendon that are quickly remedied
Rotator cuff tendinosis is more common in…
Older people with long term stress to the tendon that leads to changes in the histologic structure
Intrinsic mechanisms of rotator cuff tendinopathy
Factors that directly influence tendon health
Examples of intrinsic mechanisms of rotator cuff tendinopathy
Age
Genetics
Vascular changes
Examples of extrinsic mechanisms of rotator cuff tendinopathy
Excessive loading
Underloading then suddenly exposed to load
Improper muscle function leading to loss of humeral head control
Subacromial space loss (outlet problem)
Scapular muscle deficits leading to poor scapula control
Postural deviations (unclear)
Factors that may effect tendon healing
Obesity
Smoking
Extrinsic mechanisms of rotator cuff tendinopathy
Due to contact w/ structures such as coracoacromial arch
