Shoulder complaint Flashcards
referral from cervical or thoracic spine facet or trigger points
shoulder pain
radicular pain from cervical nerve root compression
shoulder pain
peripheral nerve and brachial plexus entrapments
shoulder pain
referral from visceral sources such as diaphragm, gallbladder, lungs or heart
shoulder pain
shoulder pain from trauma could be:
fracture, dislocation, tendon rupture
shoulder pain from overuse could be:
tendinitis, capsular sprain, bursitis
shoulder pain from arthritides could be:
osteoarthritis, RA
other sources of shoulder pain
tumor or infection
anterior shoulder pain from trauma could be:
fracture, dislocation, subacromial bursitis, capsular sprain, labrum tear
anterior shoulder pain not from trauma could be:
general impingement syndrome, biceps tendinitis, subacromial bursitis, subluxation
lateral shoulder pain from trauma could be:
contusion, supraspinatus rupture, referral from cervical spine or brachial plexus injury
lateral shoulder pain not from trauma could be:
impingement syndrome, deltoid strain, supraspinatus tear or rupture, referral from cervical spine
superior shoulder pain from trauma could be:
AC joint separation, distal clavicle fracture
superior shoulder pain not from trauma could be:
OA of AC joint, osteolysis of distal clavicle
posterior shoulder pain from trauma could be:
scapular fracture, posterior dislocation
posterior shoulder pain not from trauma could be:
posterior impingement, infraspinatus or teres minor strain, posterior deltoid strain, triceps strain, suprascapular nerve entrapment
blow to the anterior shoulder could cause
dislocation, subluxation, contusion
fall on top of shoulder could cause
AC joint separation, distal clavicle fracture
FOOSH could cause
AC separation, clavicle fracture, posterior dislocation glenoid labrum, rotator cuff tear
arm forced into external rotation and horizontal abduction with shoulder flexed to 90 degrees could cause
anterior dislocation, glenoid labrum tear
sudden contraction of the arm could cause
subluxation, brachical plexus traction injury
sudden pain with weightlifting could cause
muscle/tendon rupture, labrum tear
if pt has pain, no history of trauma, all ranges of motion are painful:
acute subacromial bursitis or early adhesive capsulitis
pt reports lateral/anterior shoulder pain with overhead activities or exhibit a painful arc
subacromial impingement, tendinitis, or bursitis
pt reports instability, apprehension, painful activities when shoulder is abducted and externally rotated
shoulder instability or labral tear if clicking
decreased ROM and pain with resistance
rotator cuff
pt reports pain and weakness with muscle loading and night pain with age greater than 60
rotator cuff
pt reports poorly located shoulder pain with aggravation by movement and relieved by rest with age greater than 45
adhesive capsulitis
most commonly overhead activities over time produce
impingement
orthos for impingement syndrome
Neers, Hawkins-Kennedy
subacromial impingement pain is here
anterior joint
infraspinatus/teres minor impingement pain is here
posterior
if painful arc between 60 and 120 degrees then:
impingement syndrome
Hawkin’s test and Neer’s test are for:
rotator cuff impingement
normal subacromial space on xray is
9-10 mm
xray shows elevation of humerus, erosion of inferior aspect of the acromion process, sclerosis, osteophytes, cystic changes
rotator cuff arthropathy with shoulder impingement
history of shoulder dislocation, pain or weakness when arm is placed in overhead position or apprehension position
traumatic instabiity
shoulder stability evaluated with these tests
load and shift test, apprehension test, relocation test
rotator cuff tear most frequently involves
supraspinatus
shoulder pain may be more noticeable at night or at rest, dull or achy pain, weakness or decreased ability to move joint, difficulty raising or lowering the arm, painful arc sign, weakness in external rotation
rotator cuff
empty can test shows
supraspinatus weakness
lift off test shows
subscapularis weakness
tests for rotator cuff
empty can test, infraspinatus muscle test, palpation
modality of choice for rotator cuff tears
MRI
on MRI, increased signal intensity in the region of the critical zone
rotator cuff tear
test to check for sprain/strain of supraspinatus
empty can test
test to check for sprain/strain of subscapularis
lift off test
test to check for sprian/strain of infraspinatus/teres minor
lag sign
test to check for sprain/strain of biceps
speed’s test
acute onset of pain that may or may not be traumatic, stiffness is progressive, pt usually over 40, abduction and external rotation decreased first then internal rotation decreased
adhesive capsulitis
all ROM are affected with acute stage (especially end range forward flexion), tenderness found anterior to AC joint on passive extension of the shoulder
subdeltoid bursitis
on xray shows calcification around head of humerus
HADD
history of popping, clicking, or catching; instability testing may be positive; may have painful sticking in movement
glenoid labrum tear (SLAP)
tests for SLAP lesion
crank test and O’Brien’s
on MRI, when looking at a straight lateral view of the shoulder this tear is from 10-2 (like on a clock)
SLAP
on MRI, when looking at a straight lateral view of the shoulder this tear is from 3-6 (like on a clock)
Bankart
on xray the normal width of AC joint
less than 5 mm
on xray the normal distance between coracoid and clavicle
11-13 mm
AC joint separation typically occurs from
FOOSH injury
on xray if the clavicle is typically less than 50% displaced it means this grade of tear
grade 2 tear
usually due to indirect force on arm while in abducted and externally rotated position; may occur during FOOSH
anterior shoulder dislocation
xray shows osseous fragment adjacent to the inferior aspect of the glenoid fossa
bankart lesion
xray shows sclerosis, mottled density, collapse, subchondral fracture, and crescent sign associated with humeral head
AVN
