Shoulder Pain

Question 1

Common cause of shoulder rotator cuff tear?

Answer 1

Genohumeral dislocation
- frequency 7-32% after dislocation

Question 2

Patients >40 with a first time dislocation and weakness >3 wks following the injury think?

Answer 2

Rotator cuff tear

Question 3

MC complication of calcific tensonitis?

Answer 3

Adhesive capsulitis

Question 4

Conditions that contribute to primary or idiopathic adhesive capsulitis?

Answer 4

Diabetes
Thyroid disease
Postmenopausal
Pulmonary neoplasm
Autoimmune d/o

Question 5

Causes of secondary adhesive capsulitis

Answer 5

Prolonged immobilization after:
- trauma
- surgery
- stroke
Or primary inflammatory condition of shoulder like
- impingement syndrome
- bicipital tendonitis

Question 6

What causes partial or complete biceps tendon rupture?

Answer 6

• Micro-tears
• age-related degeneration

Question 7

MC bicepts tendon rupturelocation?

Answer 7

Proximal

Question 8

History of injury with young patients presenting with biceps tendon tear

Answer 8

Audible snap/pop
Pain
With deformity

Question 9

Tests for biceps tendon rupture

Answer 9

Speeds test: pain in bicipital groove

Uppercut test: painful pop on anterior portion of involved shoulder

Question 10

Classic findings for biceps tendon rupture?

Answer 10

“Popeye” deformity
- distal contracture of the muscle belly
Weakness with supination
Normal elbow flexion

Question 11

Why is supination weak but elbow flexion is strong in biceps tendon rupture?

Answer 11

Intact elbow flexors:
- short head of biceps
- brachialis muscles

Question 12

Gold standard for diagnosis of biceps tendon rupture?

Answer 12

Arthroscopy

Question 13

Imaging for biceps tendon rupture

Answer 13

MRI arthrogram

Radiographs and MRI arent great

US with a good operator is as good as MRI (50%)

Question 14

Therapy for biceps tendon rupture

Answer 14

Surgery
- need ortho evaluation in 24-48hrs

Question 15

Chronic rotator cuff tear history

Answer 15

HX: gradual, progressive pain, worse at night with no specific injury
Pain localized in the lateral aspect of the upper arm
Worst with elevation, external rotation and lifting

Question 16

acute rotator cuff tear history

Answer 16

Pain, disability, and asymmetry due to swelling
Active motion limited with inability to abduct or externally rotate the arm against resistance

Question 17

Acute rotator cuff tear exam

Answer 17

TTP on lateral aspect of arm or in subacromial region
Weakness and pain on abduction, elevation, and external rotation
Drop arm test positive
Crepitus and pain with ROM

Question 18

DDX for referred shoulder pain

Answer 18

Cervical spine
Brachial plexus
Axillary artery thrombisis
Subscapular nerve injury
Thoracic outlet syndrome
Pancoat’stumor
Misc thoracoabcominal d/o

Question 19

MC source of referred pain in shoulder?

Answer 19

Neck

Question 20

C5-C6 injury may present as?

Answer 20

Rotator cuff disease

Question 21

Brachial plexus injury may present as?

Answer 21

Referred pain to shoulder
Weakness
rapid atrophy of muscle
- within one weak

Question 22

Most serious vascular injury that can cause shoulder pain?

Answer 22

Acute thrombosis of the axillary artery

Question 23

What causes thoracic outlet syndrome?

Answer 23

Compression of the brachial plexus and blood vessels proximal to the shoulder

Question 24

What does a pancoat’s tumor cause?

Answer 24

Compression of the brachial plexus against chest wall causing shoulder pain
May be
- local
- radicular
- sense of fullness in supraclavicular fossa

Question 25

Thoracic causes of referred shoulder pain

Answer 25

MI
Pneumonia,
PE
Diaphragm irritation

Question 26

Abdominal causes of referred shoulder pain

Answer 26

• Biliary tract disease
• Splenic injury/inflammation
• Perforated viscus
• rupture ectopic pregnancy