Shoulder Exam Diagnosis Flashcards
1
Q
Fall on side of arm (2)
A
AC sprain
Contusion
2
Q
FOOSH (3)
A
Labrum
AC sprain
RTC injury
3
Q
P w/ OH activity
A
Impingement
4
Q
P with Pulling/lifting motion
A
Biceps tendinopathy
5
Q
Fracture presents with what red flags? (12)
A
Acute disabling pain Significant weakness Unexplained significant sensory/motor deficit Loss of normal shape Palpable mass Exam unable to localize anatomical structure responsible for sx's Severely restricted shoulder mob History of seizure or shock History of non-investigated trauma First time dislocation Blunt trauma Age >40
6
Q
Trauma to clavicle - blow to posteriosuperior point of shoulder, FOOSH, heavy lifting
A
AC sprain
7
Q
Step defect
A
AC sprain
8
Q
Arm cradled in opposite hand
A
AC sprain
9
Q
Pain with active arm raising (Flexion or abduction), ER, active horizontal adduction
A
AC sprain
10
Q
Neck and shoulder spasms are common with this
A
AC sprain
11
Q
Palpation + positive paxinos squeeze provoke local pain here
A
AC sprain
12
Q
Follow up tests after paxinos for ac SPRAIN? (13)
A
Cross body abduction, AC resisted extension and Active compression (obrien)
13
Q
Traumatic (sudden or excessive loading) or overuse (overhead)
A
Biceps tendinopathy
14
Q
May be isolated, part of impingement syndrome or associated with anterior instability
A
Biceps tendinopathy
15
Q
Anterior shoulder.arm pain exacerbated by lifting, pulling and overhead activities
A
Biceps tendinopathy
16
Q
Point tenderness over tendon (intertubercular groove)
A
Biceps tendinopathy
17
Q
Pain with biceps resistance: elbow bent, elbow straight (speeds test)
A
Biceps tendinopathy
18
Q
Pain with passive stretch (biceps extension test)
A
Biceps tendinopathy
19
Q
May have positive impingement sign (ER, palm up)
A
Biceps tendinopathy
20
Q
If tendon unstable = history of snapping, positive modified yergasen’s
A
Biceps tendinopathy
21
Q
If unstable biceps tendon, what two pathologies must you rule out?
A
Labrum/AC
22
Q
Biceps tendinopathy often accompanies what pathology
A
Subscap pathology
23
Q
History of acute onset of anterior shoulder pain following a popping or tearing sensation
A
Biceps RUPTURE
24
Q
History of chronic tendinopathy or steroid injections
A
BICEPS RUPTURE
25
Often caused by sudden or forceful contraction or sudden stretch
BICEPS RUPTURE
26
Visible swelling or bruising may occur (or rolled up deformity)
Biceps RUPTURE
27
1' d/t infection, associated with inflammatory joint disease or direct impingement
Bursitis
28
2' to tendinopathy or calcification tendinitis
Bursitis
29
Note: bursitis can be a lone diagnosis ?
False
30
Excrutiating pain, no positional relief, may occur after period of intense shoulder use
Acute bursitis
31
ALL AROM ARE PAINFUL
Acute bursitis
32
Subtle heat or edema may be present (rare swelling)
Acute bursitis
33
Pass abduction is most painful, followed by passive IR/ER
Acute bursitis
34
Extreme tenderness on palpation of bursa (periacromial and anterior to acromium with shoulder extended or extended and IR, hand behind back)
Acute bursitis
35
Resisted muscle testing painful in ALL directions
Acute bursitis
36
Severe pain at rest and intense pain with movement in any direction
Acute calcification tendinitis
*note, kinda like acute bursitis, ya? Acute bursitis is painful in all directions with resisted muscle testing. This is movement in general.
37
Pain with most/all AROM; patient supports injured extremity with opposite hand
Acute calcific tendinitis
*note, this also seen with AC sprain, ya? :)
38
Non traumatic, sometimes associated with over use. No fever or signs of systemic disease. Painful in most.all AROM
Acute calcific tendinitis
39
May be chronic and non symptomatic for many years
Acute calcific tendinitis
40
Often MIDDLE AGED FEMALE, SEDENTARY AND NON DOMINANT ARM (uncommon in elderly, for once!)
Acute calcific tendinitis
41
Painful arc in ONE DIRECTION: elevation (flexion or abduction) or rotation
Chronic calcific tendinitis
42
Chronic calcific tendinitis may be symptom free?
Yes. If painful, not as intense and disabling as acute.
43
Pinpoint pain and crepitus. Neck pain and neck muscle spasms (traps).
AC OA
44
Very common OA location
AC
45
Localized pain at 90-180' abd
AC OA
46
No pain with resisted muscle testing with arm dependent! (Localized increase in pain with arm abducted, flexed and ER)
AC OA
47
Localized p w/ passive horizontal adduction and ER
AC OA
48
Localized pain with resisted horizontal extension, active compression test (O'Brien's thumb down) and paxinos squeeze
AC OA
49
DDX of AC OA
Post-traumatic osteolysis of the clavicle
50
Unilateral or asymmetric
GH OA
51
More common in elderly
GH OA
52
Characterized by chronicity and ebb-flow of symptoms
GH OH
53
Coarse crepitus
GH OH
54
May have history of trauma, sx, CPPD, chronic shoulder pain or chronic impingement
GH OA
55
Pain worse in AM and end of day or after heavy use
GH OA
56
Cold weather may exacerbate
GH OA
57
Pain in capsular pattern with passive ROM, making it almost indistinguishable from frozen shoulder
GH OA
58
What is capsualr pattern?
ER, AB
59
With or without recent trauma, generalized shoulder pain and disability; shoulder deformity! (Sulcus sign, loss of deltoid contour). Arm may be cradled in opposite hand. Pain in all AROM AND PROM. (Defomiryt subtle in posterior, often missed)
Dislocation/subluxation
| Cradling of arm is also seen in AC sprain, acute calcific tendinitis
60
Neurological signs present (especially ancillary nerve). Check vascular involvement
Dislocation/subluxation
61
Most common dislocation/subluxation
Anterior and often inferior
62
MC mechanisms are excessive ER of abducted arms or FOOSH
Anterior and often inferior dislocation/subluxation
63
Patient antalgic with arm held rigidly in semi abducted position
Anterior and inferior subluxation or dislocation
64
All movement excruciatingly painful
Dislocation/subluxation (note for posterior: abduction = worse)
Ddx: acute calcific tendinitis; resisted muscle testing painful in all directions - acute bursitis
65
Posterior Dugas
Anterior and often inferior dislocation/subluxation
| *note, may be negative in posterior dislocation
66
MC direction of dislocation in elderly
Posterior
67
Blow to shoulder or FOOSH with arm flexed and IR
Posterior dislocation
68
Patient antalgic with arm held in internal rotation against body
Posterior dislocation
69
Posterolateral humeral head compression fracture
Hill-sach's lesion
70
Anterior-inferior glenoid labrum or fracture of inferior glenoid rim
Bankart lesion
71
Impression fracture of numeral head
Trough sign
72
Trauma (Direct blow, fall direct on shoulder, FOOSh perhaps with pop or crunch), local pain, swelling, bruising and point tenderness.
Deformity f middle third of clavicle, pain with arm raising, lifting or pulling
Clavicle fracture
73
Traumatic fall on outstretched hand, elbow or shoulder; blow to shoulder perhaps with pop or crunch. Swelling or brushing near fracture site. Significant pain and point tenderness, occasional crepitus on palpation. Can't move arm, may be cradled in opposite hand, painful crepitus on movement. HIGHER RISK IN ELDERLY
Fracture ofhuemrus.
74
History of poor response to manipulation and rehabilitation, mastectomy, cardiopulmonary disease, DM (5-8x increased risk), thyroid dz, CVA, parkinson's, radiculopathy or neck trauma, shoulder trauma, prolonged bed rest or UE immobilization or tendinopathy/bursitis; pain with passive/active capsular stretch procedures esp. ER; NO PAIN WITH ISOMETRIC CONTRACTIONS.
Early stage capsulitis
75
No pain with isometric contractions if uncomplicated!
Early stage capsulitis
76
Constant pain/pain at night!
Early stage capsulitis
77
ROM restriction with capsular pattern! Esp. ER and ABD.
Middle stage capsulitis
78
Pain may gradually subside but motion restriction increases, sometimes only with endpoint pain during AROM and PROM
Middle stage capsulitis
79
Marked restriction of AROM AND PROM WITHOUT PAIN ESP ER AND ABD
LATE STAGE CAPSULITIS
80
LOSS OF ER>AB>F>IR
Late stage adhesive capsulitis
*ERABFIR
81
What must also be evaluated for possible associate dmild instabilkity?
Impingement
82
MC type of impingement
Superior impingement
83
Pain usually in anterior or lateral shoulder
Superior impingement syndrome
84
Associated with OH activities
Superior impingement syndrome
85
Common in swimmers
Superior impingement syndrome
86
Chronic/recurrent low grade pain, often associated with other shoulder conditions. Pain anterior or lateral shoulder
Impingement syndrome - superior
87
Positive painful arc or abduction
Impingement syndrome
88
Positive neer's, hawkins' kennedy
Impingement syndrome
89
Pain with ER (@0' abd)
Impingement syndrome
90
Point tenderness over involved structures (long head of biceps, supra, coracoromial ll)
Impingement syndrome
91
Hawkins kennedy + painful arc + pain with resisted ER, ne'er and empty can
Impingement syndrome
92
Most DIAGNOSITC: hawkin's kennedy, painful arc AND weakness in ER OR lag sign
Impingement
| Good at ruling in and out
93
Prominent pain at rest, aggravated by all movements; elevated ESR/CRP, anemia or elevated WBC. Prior history of infection, recent surgery or hospitalization or immune-compromised patient, rapid onset/progressive/destructed. Accompanied by fever, local redness
Infectious arthropathy
94
Inferior instability signs (2)
Sulcus sign/reinforced sulcus
| Positive faegin's sign
95
Anterior apprehension, relocation and release
Anterior instability
96
Apprehension during stress testing is a better prediction of what than pain alone
Instability
97
Posterior drawer sign, painful posterior shift/clunk with NORWOOD
Posterior instability
98
Pain with push up/bench press or resisted forward fleixion
Posterior instability
99
Stryker view used for what shoulder prob
Instability
100
IR + Stryker good for what lesion
Hill-sach's
101
Hill-sachs is considered pathogens on ic for what
Previous dislocation
102
This is foudn in conjunction with other shoulder diagnosis (RTC strain, impingement syndrome) but may be isolated
Joint dysfunction/subluxation syndrome
103
Painful loss of joint glide and/or restriction; abnormal end feel or joint play; may or may not have painful or decreased AROM and or PROM
Joint dysfunction/subluxation syndrome
104
MC labrum tear
SLAP lesion
105
High load trauma or repetitive micro trauma (overuse in pitcher)
Labrum tear
106
Recurrent catching/locking
Labrum tear
107
Recurrent painful click, pop. Or clunk in shoulder (ddx from bicipital snapping or AC crepitus)
Labrum tear
108
Biceps provocation and biceps load
Not that good but labrum tear
109
Obrien's active compression
Not that good alone but biceps tear. Better when combo with Passive distraction test
110
Passive compression test
Labrum tear
111
Anterior slide + crank
Labrum
112
Anterior slide + obrien's
Labrum
113
Passive rotation
Labrum
114
Passive distraction +obrien's
Labrum
115
Crank test + anterior slide
Labrum
116
Apprehensiona nd relocation, can help to rule in unstable SLAp
Labrum
117
Labrum tear responds to conservative carE?
No
118
Tender palpable nodule/band; reproduceable by palpation of trigger point, pain with stretch, referred pain patterns
Myofascial pain syndrome
119
Jump sign, twitch sign, weak muscle, short tight muscle, ddx from tender points of fibromyalgia
Myofascial pain syndrom
120
Pain at rest, worse in AM and end of day; symptoms ebb and flow often independent of mechanical stress
RA
121
May ahve systemic signs (fever and malaise)
RA
122
Multiple sites and BI, symmetrical joint involvement including hands
RA
123
Elevated ESR, CRP may ahve anemia and fine creptisi
RA
124
Nonspecific pain, or deep in joint
RA
125
P with active or passive ROM
RA
126
Consider cervical flexion extension studies for instability with this condition
RA
127
Very high likelihood of RTC if two of following occur in patient age 60+ (4)
Supra weakness
ER weakness
+ hawkins-kennedy
Very low likelihood when none of the above 3 are. +
128
Very high likelihood with +arm drop in patient age 60+
Large RCT tear
129
Prevalence increases with age, almost always over 40. Rare under 50 unless throwing athlete. MVA, past history of steroids!
Complete rupture RCT
130
Most diagnostic combo for RCT rupture:
Positive arm drop, painful arc and weakness in ER or lag sign
131
ER lag sign
Supra or infra rupture
132
IR lag
Subscap potentially rupture
133
Arm drop test
P may be associated with bursitis or any RTC ruptures
134
Painless, gIII wekaness, complete passive ROM, decreased AROM, often associated with RA
RTC RUpture
135
Often associated with RA
RTC rupture
136
P along medial border of scapula, often postural, but maybe overuse or trauma. Maybe associative D with costovertebral joint dysfunction; maybe associated wth pain, crepitus or gratin gdruing AROM or PROm; serrated tight and tender; abnormal scapular motion; traps, rhombus, levator scpaula, cervical extensor and deep cervical muscle flexors invovled
Scapulocostal syndrome
137
History of shoulder snapping especially when raising arm
Snapping scapula syndrome
138
Palpable catch.snap near superior or inferior angle with protraction-retraction or elevation-depression
Snapping scapula syndrome
139
Parascapular pain or localized superior or inferior angle pain and tenderness
Snapping scapula syndrome
140
Point tenderness, swelling sometimes bruising (Rule out fx if bruising present); pain or creptitus with active or passive abduction or ER; posterior dislocation = call 911!
SC SPRAIN!
