Shoulder Complaints Flashcards
What are the key components of evaluating an adult with shoulder pain?
History, physical examination, neurological assessment, imaging if indicated.
What are common causes of shoulder pain in adults?
Rotator cuff injuries, impingement syndrome, adhesive capsulitis, osteoarthritis, dislocations.
What historical factors should be assessed in a patient with shoulder pain?
Onset, duration, aggravating/alleviating factors, history of trauma, occupational/recreational activities.
What is the most common cause of shoulder pain in adults?
Rotator cuff pathology, including tendinopathy and tears.
What symptoms suggest rotator cuff tendinopathy?
Lateral shoulder pain, pain with overhead activity, weakness in abduction.
What symptoms suggest adhesive capsulitis (frozen shoulder)?
Progressive loss of active and passive ROM, especially external rotation.
What symptoms suggest acromioclavicular (AC) joint pathology?
Pain localized to the AC joint, worsened by cross-body adduction.
What are red flag symptoms in a patient with shoulder pain?
Severe night pain, unexplained weight loss, history of cancer, fever, neurological deficits.
What imaging modality is first-line for shoulder pain in most cases?
X-ray to assess for fractures, osteoarthritis, and dislocations.
When is MRI indicated for shoulder evaluation?
Suspected rotator cuff tear, labral injury, or soft tissue pathology after initial X-ray.
What special tests assess for shoulder impingement?
Neer test and Hawkins-Kennedy test.
What does a positive Neer test indicate?
Pain with passive shoulder flexion suggests subacromial impingement.
What does a positive Hawkins-Kennedy test indicate?
Pain with passive internal rotation suggests impingement or rotator cuff irritation.
What special test assesses for rotator cuff tears?
Empty Can (Jobe) test.
What does a positive Empty Can test indicate?
Weakness or pain with resisted abduction suggests supraspinatus involvement.
What test evaluates for shoulder instability?
Apprehension test.
What does a positive Apprehension test indicate?
Fear or discomfort with external rotation suggests anterior instability.
What is the recommended initial treatment for most shoulder complaints?
Conservative management: rest, ice, NSAIDs, physical therapy.
When should a patient with shoulder pain be referred to an orthopedic specialist?
Persistent pain despite conservative management, suspected full-thickness rotator cuff tear, significant instability.
What are common causes of referred shoulder pain?
Cervical radiculopathy, myocardial infarction, diaphragmatic irritation (e.g., gallbladder disease).
What test helps differentiate cervical radiculopathy from shoulder pathology?
Spurling’s test: pain radiating down the arm with cervical compression suggests cervical involvement.
What is the most commonly torn rotator cuff tendon?
Supraspinatus tendon.
What are the two primary causes of rotator cuff tears?
Chronic degenerative changes (most common) and acute traumatic injury.
What are risk factors for rotator cuff tears?
Age > 40, repetitive overhead movements, previous shoulder injury, smoking.
What are common symptoms of rotator cuff tears?
Shoulder pain, weakness, limited active range of motion, night pain.
How does pain in rotator cuff tears typically present?
Dull, aching pain in the lateral shoulder, worsens with overhead activity.
What symptom is more pronounced in acute rotator cuff tears?
Sudden, severe pain with immediate loss of strength.
What is the significance of passive vs. active range of motion in rotator cuff tears?
Active ROM is reduced, but passive ROM is preserved unless there is severe stiffness (e.g., adhesive capsulitis).
What test is used to diagnose a supraspinatus tear?
Drop-arm test.
What is a positive drop-arm test?
Inability to slowly lower the arm from abduction due to weakness.
What special test assesses supraspinatus function?
Empty Can (Jobe) test.
What is a positive Empty Can test?
Weakness or pain with resisted arm abduction in a thumbs-down position.
What test is used to evaluate for infraspinatus or teres minor weakness?
External rotation resistance test.
What does a positive external rotation resistance test indicate?
Weakness suggests infraspinatus or teres minor pathology, commonly seen in rotator cuff tears.
What test is used to assess subscapularis function?
Lift-off test.
What is a positive Lift-off test?
Inability to push the hand away from the lower back suggests subscapularis weakness or tear.
What imaging is first-line for evaluating rotator cuff tears?
X-ray to assess for humeral head displacement, arthritis, or calcifications.
What imaging modality is most sensitive for diagnosing rotator cuff tears?
MRI without contrast.
What finding on X-ray suggests chronic rotator cuff tear?
Superior migration of the humeral head (high-riding humeral head).
What alternative imaging modality can be used if MRI is unavailable?
Ultrasound (identifies full-thickness and some partial-thickness tears).
What is the primary treatment for partial-thickness rotator cuff tears?
Conservative management: physical therapy, NSAIDs, activity modification.
When is surgical repair indicated for rotator cuff tears?
Full-thickness tears in young, active patients or failed conservative treatment after 3–6 months.
What complications can arise from untreated rotator cuff tears?
Tear progression, shoulder weakness, adhesive capsulitis, shoulder arthritis.
