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CP 3 Shoulder Dx Quiz > Shoulder DDX > Flashcards

Shoulder DDX Flashcards

1
Q

If you suspect a muscle/tendon ddx what are 4 possible pain generator?

A
  1. large/full tear (grade 3)
  2. small tear/ tendinopathy (grade 1-2)
  3. impingement syndrome
  4. calcific tendinitis
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2
Q

If you suspect a joint/lig/bone ddx, what are 4 possible pain generators?

A
  1. AC (or SC) sprain
  2. Bursitis/capsulitits/frozen shoulder
  3. labrum tear
  4. fracture/dislocation
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3
Q

Age >65 AND ext rot weakness AND night pain dx?

A

rupture/large rotator cuff tear

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4
Q

+ ext and int rotational lag sign dx?

A

large tear, grade 3

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5
Q

+ lift off test, which muscle?

A

subscapularis

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6
Q

+ arm dropping sign/drop sign dx?

A

Infraspinatus large tear, grade 3 (may also be associated with supraspinatus rupture)

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7
Q

+ napolean’s sign/belly press dx?

A

large tear of subscapularis

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8
Q

+ hug test dx?

A

large tear of subscapularis, gr 3

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9
Q

+ arm drop/codman’s arm drop dx?

A

supraspinatus tendinopathy, may inclue a large tear

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10
Q

+ hornblower’s sign dx?

A

teres minor

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11
Q

+ codman’s arm drop AND painful arm AND ER weakness or a lag sign dx?

A

Supraspinatus large tear

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12
Q

Age > 39, painful arc, self report of popping or clicking dx?

A

Supraspinatus tendinopathy

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13
Q

hx of overhead activities/aggravation, painful arc, neer’s sign, hawkin’s kennedy, ext rotation weakness dx?

A

impingement syndrome

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14
Q

What can be impinged ? (3)

A
  1. supraspinatus
  2. long head biceps tendon
  3. subacromial bursa
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15
Q
  1. Severe pain at rest and with movement in any direction
  2. extreme sensitivity with palpation just inferior to lateral acromion
    • Gerber’s/lift off test (he said not to worry about this test)
      dx?
A

bursitis

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16
Q

Severe pain at rest ddx?

A

acute bursitis, calcific tendinitis

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17
Q
  1. severe pain at rest
  2. aggravated by ROM in all directions whether active or passive
  3. possible aggravated by horizontal adduction whether active or passive
  4. isometric mm test- painless or only mildly provocative
A

C. Capsulitis

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18
Q

1.ROM restriction in capsular pattern, sig restriction of AROM and PROM with pain, esp ext rot and abduction
2. preceded by acute symptomatic shoulder condition
3. pain with resisted mm testing
4. pain may have gradually subsided, but motion restriction increases
DX?

A

Frozen shoulder

19
Q

DX?

  1. Trauma to the clavicle (blow to posteriosuperior point of shoulder, fall on outstretched hand, heavy lifting).
  2. Swelling, possible deformity (step defect).
  3. Patient may present with arm cradled in opposite hand.
  4. Point tenderness
  5. Pain with active arm raising (flexion or abduction), external rotation, active horizontal adduction.
  6. Neck and shoulder spasms are common.
  7. These follow-up tests are recommended: cross body adduction, acromioclavicular resisted extension, and active compression (O’Brien).
A

AC sprain/joint separation

20
Q

DX?

  1. Traumatic (e.g., sudden or excessive loading) or overuse (e.g., overhead).
  2. May be isolated, part of impingement syndrome, or associated with anterior instability.
  3. Anterior shoulder/arm pain exacerbated by lifting, pulling, and overhead activities.
  4. Point tenderness over tendon (intertubercular groove).
  5. Pain with biceps resistance: elbow bent, elbow straight (Speed’s test). Unfortunately most of the individual biceps muscle tests are not very accurate.
  6. Pain with passive stretch (biceps extension test).
  7. May have positive impingement sign (with external rotation, palm up).
  8. If the tendon is unstable, history of snapping, positive modified Yergasen’s Test
  9. May cross react with some labrum tests such as biceps provocation and biceps load,
A

biceps tendinopathy

21
Q

DX?

  1. hx acute onset of anterior shoulder pain following a popping or tearing sensation
  2. hx of chronic tendinopathy or steroid injections
  3. sudden or forceful contraction or sudden stretch
  4. Weak and painful elbow flexion and/or supination, possibly no pain with contraction if complete tear
  5. rolled up deformity
  6. visible swelling or bruising occurs occasionally
A

biceps rupture

22
Q

DX?

  1. acute excruciating pain, no positional relief, may occur after period of intense use of shoulder
  2. all AROM are painful
  3. subtle heat or edema may be present
  4. passive abduction most painful, followed by passive int. or ext. rotation
  5. extreme tenderness on palpation
  6. resisted mm testing may be painful in all directions
A

Bursitis

23
Q

Dx?

  1. Often very severe pain at rest and intense pain with movement in any direction.
  2. Pain with most/all AROM; often patient supports injured extremity with opposite hand.
  3. Nontraumatic (sometimes associated with overuse).
  4. No fever or signs of systemic disease.
  5. often middle-aged female, sedentary, nondominant arm
A

Acute calcific tendinitis

24
Q

Dx?

  1. painful arm in one direction: elevation, flex or abduction or rotation
  2. may be sx-free, if painful, not as intense and disabling as acute
A

Chronic calcific tendinitis

25
Q

Dx?
Pinpoint pain and crepitus.
 Neck pain and neck muscle spasms (especially trapezius).
 Localized pain at 90-180 degrees of abduction.
 No pain with resisted muscle testing with arm dependent (localized increase in pain with arm abducted, flexed, externally rotated).
 Localized pain with passive horizontal adduction and external rotation.
 Localized pain with resisted horizontal extension, active compression test (O’Brien’s thumb down), and Paxinos squeeze.

A

AC DJD

26
Q

Dx?
1 More common in the elderly; characterized by its chronicity and ebb-flow of symptoms.
2 Coarse crepitus.
3 May have history of trauma, surgery, CPPD, chronic shoulder pain, or chronic impingement.
4 Pain may be worse in AM (gel time, 1 hour or less) and then again at end of the day, or after heavy use.
5 Cold weather may exacerbate.
6 Pain in a capsular pattern with passive ROM (external rotation, abduction) may be indistinguishable from/associated with frozen shoulder.

A

GH DJD

27
Q

DX?
Young person, ext rotation of abducted arms or FOOSH.
- patient antalgic with arm held rigidly in a semi-abducted position.
- all movement excruciatingly painful
- unable to reach across and touch opposite shoulder (Dugas test)

A

anterior dislocation

28
Q

DX?
MOI are excessive ext rotation of abducted arms or FOOSH with arm flexed and internally rotated
- pt is antalgic with arm held in internal rotation against the body
- all movement excruciatingly painful, esp abduction
- dugas may be neg in posterior dislocation

A

posterior dislocation

29
Q

Dx?

  1. trauma (direct blow, fall direct on shoulder, FOOSH, with pop or crunch
  2. local pain, swelling, bruising, point tenderness
  3. may have deformity (mid clav), pain with arm raising (flexion or adbuction) lifting or pulling
  4. neg tuning fork test cannot be used to R/O a fx
A

fx of clavicle

30
Q
  1. traumatic fall on outstretched hand, on elbow or shoulder, blow to shoulder
  2. swelling or bruising near fx site
  3. sig pain and point tenderness; occ crepitus on palpation
  4. may have deformity or displacement
  5. inability to move arm, may be cradled in opposite hand, painful crepitus on movement
  6. higher risk in elderly
A

fx of humerus

31
Q

Dx?

  1. hx of poor response to manipulation and rehabilitation may indicate capsulitis
  2. hx of mastectomy, cardiopulmonary dz, diabetes, thyroid dz, CVA, parkinson’s dz, radiculopathy or neck trauma, shoulder trauma, prolonged bed rest, or upper extremiity immobilization
  3. pain with passive and active capsular stretch procedures (esp ext. rotation), no pain with isometric contractions
  4. constant pain/pain at night
A

Frozen shoulder, early stage

32
Q

Dx?

  1. ROM restriction with capsular pattern
  2. passive external often decreased by 50%
  3. usually preceded by an acutely symptomatic shoulder condition
  4. may demonstrate pain with resisted muscle testing
  5. pain may gradually subside but motion restriction increases finally with only endpoint pain during AROM and PROM
A

Frozen shoulder, middle stage

33
Q

Dx?

  1. Marked restriction of AROM and PROM without pain (especially external rotation and abduction).
  2. Classic pattern: Loss of external rotation > loss of abduction > loss of flexion > loss of internal rotation.
A

Frozen shoulder, late stage

34
Q

1 Pain usually anterior or lateral shoulder, rarely posterior.
2 Associated with overhead activities; common in swimmers (“swimmers shoulder”).
3 Chronic/recurrent low grade pain.
4. painful arc
5. + neer’s, hawkins-kennedy
6. pain with external rotation
7. pain with loading or passive stretching of supraspinatus and/or biceps
8. worse with arm abducted or flexed

A

Impingement syndrome

35
Q

Dx?
+ Sulcus sign/reinforced sulcus.
+ Positive Faegin’s sign.

A

Inferior instability GH jt

36
Q

Dx?
+ anterior apprehension, relocation and release
+ anterior drawer sign

A

Anterior instability GH jt

37
Q

Dx?

    • posterior drawer sign
    • painful posterior shift and clunk with Norwood test
    • pain with push up/bench press, or resisted forward flexion
A

Posterior instability GH jt

38
Q

Dx?

  1. high load trauma or repetitive micro-trauma
  2. recurrent painful click, pop, or clunk in shoulder
    • biceps provocation and biceps load
    • o’brien’s , passive compression, anterior slide, passive rotation, passive distraction, crank test
A

Labrum tear

39
Q

+ empty can with resistance

A

supraspinatus rotator cuff tear/tendinopathy

40
Q

+ hug/napolean

A

subscap rotator cuff tear

41
Q

bugler’s test +

A

infraspinatus rotator cuff tear

42
Q

dx?
+ pain with passive stretch in opposite direction
+ hawkins kennedy, ext rotator weakness, supraspinatus weakness,
+ pain with AROM
single traumatic event, overuse or postural overload

A

Rotator cuff tear/tendinopathy

43
Q

dx?

  1. Point tenderness, swelling, sometimes bruising (rule out fracture when bruising is present).
  2. Pain or crepitus over SC with active or passive abduction or external rotation.
  3. Trauma to the clavicle (e.g., seatbelt).
A

SC sprain

CP 3 Shoulder Dx Quiz (1 decks)

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