Shoulder

Question 1

T/F: shoulder pain is the 3rd most common MSK reason for seeking medical care?

Answer 1

true, affects 7 to 26% of adults at any time

Question 2

T/F: most complaints arise form intrinsic causes vs extrinsic?

Answer 2

true, involving articular and periarticular structures

Question 4

most common cause of referred pain to the shoulder?

Answer 4

cervical spine

Question 4

T/F: prevalence of symptomatic rotator cuff disorders increase with age

Answer 4

true, 3% older than 30 and 15% older than 70

Question 5

what is the first step in the diagnostic approach for shoulder pain?

Answer 5

consider intrinsic vs extrinsic causes

Question 6

T/F: for extrinsic causes the shoulder pain should increase with shoulder and arm movement?

Answer 6

false, this is intrinsic. If the pain is not related to shoulder and arm movements then examine extrinsic causes

Question 7

what does pain with BOTH active and passive motions suggest?

Answer 7

involvement of the glenohumeral joint (eg. osteoarthritis, frozen shoulder, gout)

or AC joint disease

Question 7

diagnosis approach for intrinsic causes?

Answer 7

trauma?
Yes - fracture, dislocation, or tear

no trauma
- whether pain occurs with active ROM?

Question 8

what does pain with ONLY active suggest?

Answer 8

soft tissue disorders such as rotator cuff or biceps tendonitis, rotator cuff tendinopathy/teaers, or subacrominal bursitis

Question 9

what does pain with elevation of arm above head suggest?

Answer 9

impingment syndrome

Question 9

what does pain on lifting items with the biceps or pain with wrist supination suggest?

Answer 9

biceps tendinitis

Question 10

most common causes of intrinsic shoulder pain?

Answer 10

impingment syndrome / rotator cuff tendinitis (50-80%)

Question 10

intrinsic causes of shoulder pain?

Answer 10

inflammatory arthritides
infection of joint or tissues
osteoartitis
polymyalgia rheumatica
osteonecrosis

note: can have more than one diagnosis 77%

Question 11

causes of extrinsic shoulder pain?

Answer 11

chest disorders
abdominal and pelvic disorders
neurological disorders
esophageal disease
vascular insufficiency

Question 12

extrinsic LEFT shoulder pain abdominal disorders?

Answer 12

splenic infarction or rupture

Question 13

extrinsic RIGHT shoulder pain abdominal disorders?

Answer 13

hepatic abscess or hematoma
cholecystitis

Question 14

difference between tendinopathy and tendonitis?

Answer 14

tendinopathy - degeneration or collagen protein that forms tendons
tendonitis - inflammation of the tendon

Question 14

extrinsic left and/or right shoulder pain abdominal disorders?

Answer 14

subphrenic abscess
intra-abdominal hemorrhage
ruptured abdominal viscus

Question 15

that tears have a higher probability to progress to a full thickness tear?

Answer 15

partial tears bigger than 50%, smaller than 50% can be treated conservatively

Question 16

Can you confirm a partial tear from physical exams?

Answer 16

no need imaging

Question 16

why are bursal side tears have a tendency to heal?

Answer 16

adequate blood suppy

Question 17

what are PASTA tears?

Answer 17

Partial articular surface tears

more frequent, tendency to progress to full-thickness

Question 18

what type of partial tear occurs in younger population and are related to trauma?

Answer 18

insertional tears

Question 19

where does a full thickness tear extend from and to? what affects the prognosis?

Answer 19

from articular side to bursal side.

size, shape, tendons, retraction.

Question 20

where are most tears found?

Answer 20

supraspinatus

and subscapularis

Question 21

what is the implication of fat atrophy?

Answer 21

if atrophy is >50% of muscle, high rate of recurrence after sugrical repair

Question 22

what classifies a massive rotator cuff tear?

Answer 22

involvement of 2 or more tendons and a retraction >5cm

progressive migration of humeral head superiorly

glenohumeral arthrosis

Question 23

what is the most common symptom of RCD?

Answer 23

pain and weakness during overhead activities
(dull pain becoming sharp)

Question 24

is the presence of pain required to diagnosis RCD?

Answer 24

no, a chronic full-thickness rotator cuff tear may present painless loss of active motion