Shoulder and Upper Quadrant Flashcards

1
Q

What are the most common cancers that metastasize to the shoulder, and why is past medical history important in shoulder pain screening?

A
  • Breast and lung cancer are most common.
  • Past medical history is crucial as it helps identify potential systemic causes of shoulder pain.
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2
Q

Explain the significance of multi-segmental innervation and diaphragmatic irritation in the context of shoulder pain.

A
  • Multi-segmental innervation allows pain to be referred to the shoulder from other body parts
  • Diaphragmatic irritation can cause sharp pain in specific areas due to shared innervation at C3-C5.
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3
Q

What are the key risk factors associated with shoulder pain that suggest a cardiac origin?

A

Risk factors include:

  • age > 50
  • postmenopausal female
  • family history of heart disease
  • history of hypertension or diabetes
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4
Q

When should adhesive capsulitis be considered in a patient with shoulder pain?

A

It should be considered in older adults or patients with risk factors like Graves’ disease or diabetes mellitus.

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5
Q

Describe how shoulder pain can be differentiated as being of visceral origin rather than musculoskeletal.

A

Visceral pain may increase with…

  • shoulder movements
  • have no direct mechanical cause
  • can be accompanied by systemic symptoms like GI issues or diaphoresis
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6
Q

Which organs can refer pain to the left shoulder, and what symptoms might accompany this pain?

A
  • heart =
  • spleen =
  • pancreas =
  • left lung =
  • kidney / adrenal gland =
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7
Q

What specific features suggest pulmonary causes for shoulder pain?

A
  • sharp, localized pain aggravated by breathing
  • relief by lying on the affected side
  • symptoms like cough or pleuritic pain
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8
Q

What screening questions should you ask to rule out cardiovascular causes of shoulder pain?

A
  • “Does your mouth, jaw, or teeth hurt when your shoulder is bothering you?”
  • “Does nitroglycerin relieve your shoulder pain?”
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9
Q

Why is it important to check vital signs when assessing shoulder pain for a potential cardiovascular origin?

A

Changes in vital signs may indicate systemic conditions like heart disease or pericarditis, which can cause shoulder pain.

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10
Q

What are some of the classic signs and symptoms of diaphragmatic irritation referring to the shoulder?

A

Pain in the upper trapezius, neck, or supraclavicular fossa from central irritation, or ipsilateral pain from peripheral irritation.

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11
Q

How can gastrointestinal issues like gallbladder disease refer pain to the shoulder?

A

GI pain may present in the right shoulder due to diaphragmatic irritation, with symptoms like nausea, vomiting, or pain related to meals.

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12
Q

When assessing for renal or urinary causes of shoulder pain, what key factors should be considered?

A

Look for ipsilateral shoulder and flank pain, elevated temp, changes in urinary habits, and a history of kidney infections or stones.

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13
Q

What distinguishes neuromuscular or neurologic causes of shoulder pain, like thoracic outlet syndrome?

A

Thoracic outlet syndrome is characterized by neurogenic pain, possibly radiating to the neck, axilla, and ulnar nerve distribution.

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14
Q

What is Kehr’s sign, and what does its presence indicate in a patient with shoulder pain?

A

Kehr’s sign is referred to the left shoulder on gentle palpation of the abdomen when the patient is lying down with legs elevated. It is classically associated with splenic rupture.

  • Can be due to diaphragmatic irritation, often associated with splenic injury or post-laparoscopic procedures.
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15
Q

Describe how Complex Regional Pain Syndrome (CRPS) may present in the upper extremity.

A

CRPS presents with chronic pain disproportionate to the injury, sensory, vasomotor, sudomotor changes, and possible muscle atrophy.

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16
Q

What systemic signs might indicate an infectious cause of shoulder pain?

A

Constitutional symptoms like fever, malaise, or localized redness and warmth around the shoulder joint.

17
Q

Which screening questions should be asked for potential GI causes of shoulder pain?

A
  • “Have you had any nausea, vomiting, difficulty swallowing, loss of appetite, or heartburn since your shoulder started hurting?”
18
Q

How can a patient’s history of recent laparoscopic surgery influence your differential diagnosis of shoulder pain?

A

Recent laparoscopic surgery may cause diaphragmatic irritation, leading to referred shoulder pain.

19
Q

What role do postural changes play in differentiating pulmonary causes of shoulder pain?

A

Pulmonary pain typically doesn’t worsen with postural changes unless associated with pleuritic components.

20
Q

Why might leaning forward relieve shoulder pain in patients with pericarditis?

A

Leaning forward reduces the pressure on the pericardium, easing the pain referred to the shoulder.

21
Q

How can a thoracic aneurysm present in relation to shoulder pain?

A

It may refer pain to the shoulder or upper extremity, typically without isolated shoulder pain.

22
Q

What screening questions help rule out a cardiovascular cause in a patient with known heart disease?

A

“Does your shoulder pain decrease when you take nitroglycerin or lean forward?”

23
Q

What does the Budapest Criteria help diagnose, and what are the key signs?

A

It helps diagnose CRPS, requiring three out of four categories:

  • sensory
  • vasomotor
  • sudomotor, and
  • motor changes
24
Q

What is the significance of pain that worsens 2-4 hours after taking NSAIDs in the context of shoulder pain?

A

It may indicate a GI cause, such as ulceration or other irritation exacerbated by NSAID use.

25
Q

Why is it important to screen joints above and below the shoulder when assessing pain?

A

Pain in the shoulder could be referred from nearby joints or structures like the neck, making a thorough examination necessary.

26
Q

What systemic red flags should raise suspicion of an infectious cause of shoulder pain?

A

History of IV drug use, recent trauma, diabetes, or age >80 years with insidious onset of shoulder pain.

27
Q

What conditions are commonly associated with shoulder pain that presents with a pleuritic component?

A

Pulmonary conditions such as infection or pleuritis, where the pain is sharp and worsens with respiratory movements.

28
Q

How should the clinical presentation of shoulder pain be approached when considering systemic causes?

A

Assess risk factors, past medical history, and associated symptoms that suggest non-mechanical origins.

29
Q

Which factors would make you suspect a neuromuscular cause of shoulder pain over a visceral one?

A

Presence of postural issues, occupational risks, or history of repetitive overhead activities.

30
Q

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A

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