Shoulder Differential Diagnosis (DDx) Flashcards
Ligamentous
Passive restraints/components of the shoulder
Accessory motion testing (mobility)
Neuromuscular
Production of movement or control of shoulder
Movement, functional, coordination testing
Joint related
Intra-articular - AC, SC, GH, ST
Accessory motion testing (mobility)
Muscle
Contractile, responds to resistance and length
Strength, power, endurance
Muscle performance testing
Neurogenic
TOS
Cervical
Neuro screen/testing
Rotator cuff tendinopathy - Supra-/Infraspinatus Pathophysiology
- Repetitive trauma via tension or compression
(or both) to the tendon of the supraspinatus
and/or infraspinatus tendon - Excessive use outlasts the tendon’s capacity
for strength/ endurance - Micro tearing can cause inflammatory
response resulting in loss of strength at the site - Chronic irritation results in fatty deposits in
muscle and tendon
Patient details for RC tendinopathy
- Age:
- Acute – 20-40 y/o
- Chronic 30-70 y/o
- Gender:
- Fairly equal
- Morphology:
- Dominant hand
- Obese
- Overuse
- Past Medical History (PMH):
- Smoking
- Obesity
- Diabetes Mellites
- Provocative activity
Subjective reports for RC tendinopathy
MOI or insidious onset
acute or chronic exacerbation
* Pain with OH movements
* Pain at night sleeping
* Improves with lack of use
Objective finding for RC tendinopathy
Painful arc
* Painful ER resistance
* Weakness of ER (infra-), worse
at 90 deg abduction (supra-)
* Abnormal scapular
mechanics
* Pain at tendon insertion
and referral to deltoid
Rotator Cuff – Complete Tear
Pathophysiology
Repetitive trauma via tension or
compression (or both) to the
tendon of the supraspinatus
and/or infraspinatus tendon
* 1 time traumatic event where the
capacity/strength of tendon wasn’t
prepared for the load/resistance.
Tear or failure occurs
RC Complete tear Patient details
Age:
* 30% of people over 60y/o
* 17% asymptomatic
* Gender:
* Fairly equal W>M
* Morphology:
* Dominant hand
* Obese
* Past Medical History (PMH):
* Smoking
* Obesity
* Diabetes Mellites
Subjective reports for RTC Complete tear
- MOI or insidious onset chronic issue
with worsening symptoms - Weakness/pain with OH
- Pain more constant throughout day and at night sleeping
Global ROM loss
Objective findings RC Complete tear
- Loss of AROM
- Significant Weak/Painful ER
resistance - Abnormal scapular mechanics
- IR involvement if large tear
(subscapularis)
Biceps tendonitis (pain in front of shoulder) Pathophysiology
-Proximal (long head) of biceps
tendon presents as anterior
shoulder pain with insidious onset
-Overhead activities may contribute
to cause and provocation
-New overhead activity or increase
in activity suspected inflammation
at the biceps tendon and
surrounding sheath
-Commonly a secondary cause
versus the primary issue
Biceps tendonitis Patient Details
- Age:
- 20-45 y/o
- Gender
- Equal
- Morphology
- All variations
- Past Medical History (PMH)
- Similar to RTC
Subjective reports for Biceps tendonitis
- Anterior shoulder pain at biceps tendon
- Worse with OH activities
- Recent increase in activity suspected
- Pain going down the anterior arm
(following biceps brachii) - Clicking/popping at biceps tendon if
unstable
Objective findings for Biceps tendonitis
- AROM painful, moreso overhead
- Painful elbow flexion
- Painful palpation
- Painful biceps special testing
- Ruled out RTC involvement
- Cervical nerve roots ruled out
- Secondary impairments at scapulae and
thoracic spine - Consider labral testing if indicated (SLAP)
Bursitis Pathophysiology
Aggravation and inflammation of the
subacromial bursa due to mechanical
compression
Common overuse pain generator
Common to be a secondary painful component with RTC, labrum or joint related pathology
Bursitis Patient details
- Age:
- Varies
- Gender
- Equal
- Morphology
- Similar to RTC
- Past Medical History (PMH)
- Similar to RTC
Subjective reports for subacromial bursitis
- Similar to RTC
- Pinpoint pain, to the subacromial
space - Pain with movements that
compress the space (OH,
adduction, rotation extremes)
Objective findings for subacromial bursitis
- Impingement testing positive
- Rule in/out contribution from RTC
and intra-articular structures
Adhesive Capsulitis (frozen shoulder) Pathophysiology
- Primary can occur spontaneously whereas
secondary can occur following trauma or
surgery - 4 Stages of progression
- Inflammation at the synovial capsule
(synovitis) leading to fibrosis and dense
collagenous tissue within the capsule - Often in nondominant hand
- 3-5% incidence in general population
- Self limiting at 1-3 years, long lasting
symptoms can persist
Adhesive Capsulitis (frozen shoulder) Patient details
- Age
- Over 40 y/o
- Ethnicity
- White may increased risk
- Gender
- Female > Male
- Morphology
- Overweight, obese
- Past Medical History (PMH)
- Family history
- Thyroid disease, CV disease
- DBM: Incidence in patients
with diabetes is as high as
20%
Subjective reports for Adhesive Capsulitis (frozen shoulder)
Intense pain and loss of motion in early phases,
less pain more loss of motion later on
Seemingly gradual/insidious onset if primary
Pain with all motions
Minimal relief reported
