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CP III > Shoulder Exam Diagnosis > Flashcards

Shoulder Exam Diagnosis Flashcards

1
Q

Fall on side of arm (2)

A

AC sprain

Contusion

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2
Q

FOOSH (3)

A

Labrum
AC sprain
RTC injury

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3
Q

P w/ OH activity

A

Impingement

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4
Q

P with Pulling/lifting motion

A

Biceps tendinopathy

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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
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6
Q

Trauma to clavicle - blow to posteriosuperior point of shoulder, FOOSH, heavy lifting

A

AC sprain

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7
Q

Step defect

A

AC sprain

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8
Q

Arm cradled in opposite hand

A

AC sprain

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9
Q

Pain with active arm raising (Flexion or abduction), ER, active horizontal adduction

A

AC sprain

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10
Q

Neck and shoulder spasms are common with this

A

AC sprain

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11
Q

Palpation + positive paxinos squeeze provoke local pain here

A

AC sprain

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12
Q

Follow up tests after paxinos for ac SPRAIN? (13)

A

Cross body abduction, AC resisted extension and Active compression (obrien)

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13
Q

Traumatic (sudden or excessive loading) or overuse (overhead)

A

Biceps tendinopathy

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14
Q

May be isolated, part of impingement syndrome or associated with anterior instability

A

Biceps tendinopathy

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15
Q

Anterior shoulder.arm pain exacerbated by lifting, pulling and overhead activities

A

Biceps tendinopathy

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16
Q

Point tenderness over tendon (intertubercular groove)

A

Biceps tendinopathy

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17
Q

Pain with biceps resistance: elbow bent, elbow straight (speeds test)

A

Biceps tendinopathy

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18
Q

Pain with passive stretch (biceps extension test)

A

Biceps tendinopathy

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19
Q

May have positive impingement sign (ER, palm up)

A

Biceps tendinopathy

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20
Q

If tendon unstable = history of snapping, positive modified yergasen’s

A

Biceps tendinopathy

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21
Q

If unstable biceps tendon, what two pathologies must you rule out?

A

Labrum/AC

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22
Q

Biceps tendinopathy often accompanies what pathology

A

Subscap pathology

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23
Q

History of acute onset of anterior shoulder pain following a popping or tearing sensation

A

Biceps RUPTURE

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24
Q

History of chronic tendinopathy or steroid injections

A

BICEPS RUPTURE

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25
Q

Often caused by sudden or forceful contraction or sudden stretch

A

BICEPS RUPTURE

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26
Q

Visible swelling or bruising may occur (or rolled up deformity)

A

Biceps RUPTURE

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27
Q

1’ d/t infection, associated with inflammatory joint disease or direct impingement

A

Bursitis

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28
Q

2’ to tendinopathy or calcification tendinitis

A

Bursitis

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29
Q

Note: bursitis can be a lone diagnosis ?

A

False

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30
Q

Excrutiating pain, no positional relief, may occur after period of intense shoulder use

A

Acute bursitis

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31
Q

ALL AROM ARE PAINFUL

A

Acute bursitis

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32
Q

Subtle heat or edema may be present (rare swelling)

A

Acute bursitis

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33
Q

Pass abduction is most painful, followed by passive IR/ER

A

Acute bursitis

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34
Q

Extreme tenderness on palpation of bursa (periacromial and anterior to acromium with shoulder extended or extended and IR, hand behind back)

A

Acute bursitis

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35
Q

Resisted muscle testing painful in ALL directions

A

Acute bursitis

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36
Q

Severe pain at rest and intense pain with movement in any direction

A

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.

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37
Q

Pain with most/all AROM; patient supports injured extremity with opposite hand

A

Acute calcific tendinitis

*note, this also seen with AC sprain, ya? :)

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38
Q

Non traumatic, sometimes associated with over use. No fever or signs of systemic disease. Painful in most.all AROM

A

Acute calcific tendinitis

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39
Q

May be chronic and non symptomatic for many years

A

Acute calcific tendinitis

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40
Q

Often MIDDLE AGED FEMALE, SEDENTARY AND NON DOMINANT ARM (uncommon in elderly, for once!)

A

Acute calcific tendinitis

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41
Q

Painful arc in ONE DIRECTION: elevation (flexion or abduction) or rotation

A

Chronic calcific tendinitis

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42
Q

Chronic calcific tendinitis may be symptom free?

A

Yes. If painful, not as intense and disabling as acute.

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43
Q

Pinpoint pain and crepitus. Neck pain and neck muscle spasms (traps).

A

AC OA

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44
Q

Very common OA location

A

AC

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45
Q

Localized pain at 90-180’ abd

A

AC OA

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46
Q

No pain with resisted muscle testing with arm dependent! (Localized increase in pain with arm abducted, flexed and ER)

A

AC OA

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47
Q

Localized p w/ passive horizontal adduction and ER

A

AC OA

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48
Q

Localized pain with resisted horizontal extension, active compression test (O’Brien’s thumb down) and paxinos squeeze

A

AC OA

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49
Q

DDX of AC OA

A

Post-traumatic osteolysis of the clavicle

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50
Q

Unilateral or asymmetric

A

GH OA

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51
Q

More common in elderly

A

GH OA

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52
Q

Characterized by chronicity and ebb-flow of symptoms

A

GH OH

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53
Q

Coarse crepitus

A

GH OH

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54
Q

May have history of trauma, sx, CPPD, chronic shoulder pain or chronic impingement

A

GH OA

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55
Q

Pain worse in AM and end of day or after heavy use

A

GH OA

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56
Q

Cold weather may exacerbate

A

GH OA

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57
Q

Pain in capsular pattern with passive ROM, making it almost indistinguishable from frozen shoulder

A

GH OA

58
Q

What is capsualr pattern?

A

ER, AB

59
Q

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)

A

Dislocation/subluxation

Cradling of arm is also seen in AC sprain, acute calcific tendinitis

60
Q

Neurological signs present (especially ancillary nerve). Check vascular involvement

A

Dislocation/subluxation

61
Q

Most common dislocation/subluxation

A

Anterior and often inferior

62
Q

MC mechanisms are excessive ER of abducted arms or FOOSH

A

Anterior and often inferior dislocation/subluxation

63
Q

Patient antalgic with arm held rigidly in semi abducted position

A

Anterior and inferior subluxation or dislocation

64
Q

All movement excruciatingly painful

A

Dislocation/subluxation (note for posterior: abduction = worse)

Ddx: acute calcific tendinitis; resisted muscle testing painful in all directions - acute bursitis

65
Q

Posterior Dugas

A

Anterior and often inferior dislocation/subluxation

*note, may be negative in posterior dislocation

66
Q

MC direction of dislocation in elderly

A

Posterior

67
Q

Blow to shoulder or FOOSH with arm flexed and IR

A

Posterior dislocation

68
Q

Patient antalgic with arm held in internal rotation against body

A

Posterior dislocation

69
Q

Posterolateral humeral head compression fracture

A

Hill-sach’s lesion

70
Q

Anterior-inferior glenoid labrum or fracture of inferior glenoid rim

A

Bankart lesion

71
Q

Impression fracture of numeral head

A

Trough sign

72
Q

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

A

Clavicle fracture

73
Q

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

A

Fracture ofhuemrus.

74
Q

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.

A

Early stage capsulitis

75
Q

No pain with isometric contractions if uncomplicated!

A

Early stage capsulitis

76
Q

Constant pain/pain at night!

A

Early stage capsulitis

77
Q

ROM restriction with capsular pattern! Esp. ER and ABD.

A

Middle stage capsulitis

78
Q

Pain may gradually subside but motion restriction increases, sometimes only with endpoint pain during AROM and PROM

A

Middle stage capsulitis

79
Q

Marked restriction of AROM AND PROM WITHOUT PAIN ESP ER AND ABD

A

LATE STAGE CAPSULITIS

80
Q

LOSS OF ER>AB>F>IR

A

Late stage adhesive capsulitis

*ERABFIR

81
Q

What must also be evaluated for possible associate dmild instabilkity?

A

Impingement

82
Q

MC type of impingement

A

Superior impingement

83
Q

Pain usually in anterior or lateral shoulder

A

Superior impingement syndrome

84
Q

Associated with OH activities

A

Superior impingement syndrome

85
Q

Common in swimmers

A

Superior impingement syndrome

86
Q

Chronic/recurrent low grade pain, often associated with other shoulder conditions. Pain anterior or lateral shoulder

A

Impingement syndrome - superior

87
Q

Positive painful arc or abduction

A

Impingement syndrome

88
Q

Positive neer’s, hawkins’ kennedy

A

Impingement syndrome

89
Q

Pain with ER (@0’ abd)

A

Impingement syndrome

90
Q

Point tenderness over involved structures (long head of biceps, supra, coracoromial ll)

A

Impingement syndrome

91
Q

Hawkins kennedy + painful arc + pain with resisted ER, ne’er and empty can

A

Impingement syndrome

92
Q

Most DIAGNOSITC: hawkin’s kennedy, painful arc AND weakness in ER OR lag sign

A

Impingement

Good at ruling in and out

93
Q

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

A

Infectious arthropathy

94
Q

Inferior instability signs (2)

A

Sulcus sign/reinforced sulcus

Positive faegin’s sign

95
Q

Anterior apprehension, relocation and release

A

Anterior instability

96
Q

Apprehension during stress testing is a better prediction of what than pain alone

A

Instability

97
Q

Posterior drawer sign, painful posterior shift/clunk with NORWOOD

A

Posterior instability

98
Q

Pain with push up/bench press or resisted forward fleixion

A

Posterior instability

99
Q

Stryker view used for what shoulder prob

A

Instability

100
Q

IR + Stryker good for what lesion

A

Hill-sach’s

101
Q

Hill-sachs is considered pathogens on ic for what

A

Previous dislocation

102
Q

This is foudn in conjunction with other shoulder diagnosis (RTC strain, impingement syndrome) but may be isolated

A

Joint dysfunction/subluxation syndrome

103
Q

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

A

Joint dysfunction/subluxation syndrome

104
Q

MC labrum tear

A

SLAP lesion

105
Q

High load trauma or repetitive micro trauma (overuse in pitcher)

A

Labrum tear

106
Q

Recurrent catching/locking

A

Labrum tear

107
Q

Recurrent painful click, pop. Or clunk in shoulder (ddx from bicipital snapping or AC crepitus)

A

Labrum tear

108
Q

Biceps provocation and biceps load

A

Not that good but labrum tear

109
Q

Obrien’s active compression

A

Not that good alone but biceps tear. Better when combo with Passive distraction test

110
Q

Passive compression test

A

Labrum tear

111
Q

Anterior slide + crank

A

Labrum

112
Q

Anterior slide + obrien’s

A

Labrum

113
Q

Passive rotation

A

Labrum

114
Q

Passive distraction +obrien’s

A

Labrum

115
Q

Crank test + anterior slide

A

Labrum

116
Q

Apprehensiona nd relocation, can help to rule in unstable SLAp

A

Labrum

117
Q

Labrum tear responds to conservative carE?

A

No

118
Q

Tender palpable nodule/band; reproduceable by palpation of trigger point, pain with stretch, referred pain patterns

A

Myofascial pain syndrome

119
Q

Jump sign, twitch sign, weak muscle, short tight muscle, ddx from tender points of fibromyalgia

A

Myofascial pain syndrom

120
Q

Pain at rest, worse in AM and end of day; symptoms ebb and flow often independent of mechanical stress

A

RA

121
Q

May ahve systemic signs (fever and malaise)

A

RA

122
Q

Multiple sites and BI, symmetrical joint involvement including hands

A

RA

123
Q

Elevated ESR, CRP may ahve anemia and fine creptisi

A

RA

124
Q

Nonspecific pain, or deep in joint

A

RA

125
Q

P with active or passive ROM

A

RA

126
Q

Consider cervical flexion extension studies for instability with this condition

A

RA

127
Q

Very high likelihood of RTC if two of following occur in patient age 60+ (4)

A

Supra weakness
ER weakness
+ hawkins-kennedy
Very low likelihood when none of the above 3 are. +

128
Q

Very high likelihood with +arm drop in patient age 60+

A

Large RCT tear

129
Q

Prevalence increases with age, almost always over 40. Rare under 50 unless throwing athlete. MVA, past history of steroids!

A

Complete rupture RCT

130
Q

Most diagnostic combo for RCT rupture:

A

Positive arm drop, painful arc and weakness in ER or lag sign

131
Q

ER lag sign

A

Supra or infra rupture

132
Q

IR lag

A

Subscap potentially rupture

133
Q

Arm drop test

A

P may be associated with bursitis or any RTC ruptures

134
Q

Painless, gIII wekaness, complete passive ROM, decreased AROM, often associated with RA

A

RTC RUpture

135
Q

Often associated with RA

A

RTC rupture

136
Q

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

A

Scapulocostal syndrome

137
Q

History of shoulder snapping especially when raising arm

A

Snapping scapula syndrome

138
Q

Palpable catch.snap near superior or inferior angle with protraction-retraction or elevation-depression

A

Snapping scapula syndrome

139
Q

Parascapular pain or localized superior or inferior angle pain and tenderness

A

Snapping scapula syndrome

140
Q

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!

A

SC SPRAIN!

CP III (3 decks)

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