Shoulder OA Flashcards
Hx
67 yr old retired electrician significant R shoulder pain, began gradually, worse over past 2 yrs, worsened by overhead activity, disturbs sleep after tennis, proximal R humeral fracture after fall from horse 20 yrs ago, managed conservatively. HTN + hypercholesterolaemia.
look/ inspect
reduced muscle bulk right deltoid
disuse atrophy
feel
tenderness over right glenohumeral joint
crepitus
active and passive movement
reduced and painful ROM of R shoulder
particularly lateral rotation R shoulder
resisted movement
no pain or weakness
special tests
scarf test for AC joint
Empty can test
Apprehension test for instability in ligaments
other exam findings
possible OA changes hands
cervical spine exam
neuro exam upper limb
DDx
OA R glenohumeral/ shoulder joint adhesive capsulitis RA Gout Rotator cuff pathology
Why is OA likely
Hx pain gradual onset worsened with activity previous fracture
Why is adhesive capsulitis/RA/gout unlikely?
Hx frozen shoulder 18 months of pain then stiffness, no hx of RA, no FHx of RA, asymmetrical joint presentation, gout possible due to metabolic risk factors but more common in feet/wrists/ankles
exam frozen shoulder possible, no RA changes in hands, gout tophi
Why is rotator cuff pathology unlikely?
no pain or weakness reproduced with resisted movement
Investigations GP
bloods [routine + arthritis screen + ESR/CRP/ uric acid]
X-ray shoulder
CT shoulder
MRI shoulder
X-ray shoulder
AP, true AP, axillary X-ray R shoulder
subchondral sclerosis
osteophytes at inf aspect of humeral head goat beard
RA erosive pattern
CT shoulder
inflammatory arthritis if large bony defects on X-ray
MRI shoulder
evaluate rotator cuff tendon
