Lecture 8: Shoulder Complaint

Question 1

What makes the shoulder joint special?

Answer 1

Rotator cuff tendons pass between bones (acromion and humerus)

• Pros: great flexibility
• more susceptible to injury

Question 2

What bones make up shoulder?

Answer 2

Clavicle
Scapula (Acromion)
Humerus

Question 3

What are the steps of a shoulder joint exam?

Answer 3

1. Inspection
2. Palpation
3. Range of Motion
4. Speciality Testing

Question 4

What is Painful Arc Test?

Answer 4

Test for subacromial impingement and rotator cuff tendon injury
-Positive if there is pain from 60-120 degrees

Question 5

What is the first step in order to diagnose shoulder pain?

Answer 5

Check if it is traumatic or atraumatic

Question 6

What can be possibly injured in traumatic shoulder pain?

Answer 6

Bones: fractures or dislocation
Soft Tissue: Myofascial, Rotator Cuff, Acromial clavicular
Joints: cartilage, hemarthrosis, joint capsule

Question 7

What can can cause atraumatic shoulder pain?

Answer 7

Extrinsic: referred pain (e.g. heart attack)
Intrinsic: Overuse injuries, shoulder instability, septic arthritis, etc

Question 8

Where are possible fractures or dislocations in shoulder?

Answer 8

• Fractures: clavicle (mostly in kids), proximal humerus (mostly in old people), scapula (blunt trauma)
• Dislocations: Glenohumeral (most often anterior)

Question 9

Where are possible soft tissue injuries in shoulder?

Answer 9

• Ligamentous injuries (ex Acromial Clavicular ligament)

- Tendon injuries (rotator cuff)

Question 10

What is most common cause for acromioclavicular joint injuries?

Answer 10

Direct blow or falling onto shoulder

Question 11

What muscles make up Rotator Cuff?

Answer 11

Supraspinatus (Tendon of Supraspinatus M. most injured)
Infraspinatus
Teres Minor M.
Subscapularis M.

Question 12

What are common ways to injure Rotator Cuff muscle?

Answer 12

Repetitive overhead activity (work or sports)

• Impingement syndrome: compression of Rotator cuff tendons
• Tendon Injury: sprain or tear
• Tendinopathy: chronic injury to tendons

Question 13

What are some extrinsic causes of shoulder pain?

Answer 13

Neurologic: cervical radiculopathy, brachial plexus, herpes zoster, thoracic outlet syndrome, etc

Abdominal: Hepatobiliary disease, diaphragmatic irritation

Cardiovascular: Acute MI, thrombosis

Pulmonary: Pneumonia, lung tumor, pulmonary embolism

Question 14

What are intrinsic causes of shoulder pain?

Answer 14

• Overuse
• Shoulder instability
• Rotator Cuff issues
• Bursitis
• Synovitis
• many more

Question 15

What are most common acute reasons for shoulder pain?

Answer 15

• Rotator Cuff Injuries
• Clavicle and Proximal Humerus Fractions
• Glenohumeral Joint Dislocations
• Acromioclavicular joint injuries
• Myofascial injury

Question 16

What are most common life threatening reasons for shoulder pain?

Answer 16

• Septic Arthritis

- Referred pain from MI, Lung Pathology, Intraperitoneal Hemorrhage