Shoulder Pain Flashcards
What are the three most common causes of musculoskeletal complaints?
- Low back pain
- Neck pain
- Shoulder pain
What are the common classifications of pain?
- Nociceptive pain (local)
- Neuropathic pain
- Referred pain
What is nociceptive pain?
Local pain due to activation of peripheral nociceptor terminal endings
What is neuropathic pain?
Pain stemming from intrinsic disease or injury to the nervous system (ie. radiculopathy, diabetic neuropathy, multiple sclerosis)
What is referred pain?
Musculoskeletal and visceral referred pain (feeling pain elsewhere)
If sensory nerves from two different sources synapse on the same second order neurons, then nociception originating the territory of one nerve can be felt as pain in the territory of the other nerve
What theory is this?
Convergent theory of referred pain
What is the convergent theory of referred pain?
If sensory nerves from two different sources synapse on the same second order neurons, then nociception in one territory can be felt as pain in another territory
Where might the liver and gallbladder refer pain?
Right shoulder
Where might the lungs and diaphragm refer pain?
Neck
Where might the heart refer pain?
Left pectoral, inside of left arm, and around T1
Diagnosis is ___% history, ___% examination, and ___% imaging and other tests
70% history
20% examination
10% imaging and other tests
What is a red flag?
Signs and symptoms from the history, physical exam, and response to care that are uncommon in the usual patient with mechanical shoulder pain, which can alert the doctor to the possibility of a more serious condition
Red flags help the doctor to rule in/rule out:
- Life threatening conditions
- Serious conditions or illnesses
- Visceral disorders
What is differential diagnosis?
List of possible disorders that could be causing the patient’s signs or symptoms
When does the differential diagnosis process begin?
Beginning of patient history
What are four techniques for generating diagnostic hypotheses?
- Key clue
- Cluster of clues
- Template matching
- Pattern Recognition
When considering the signs and symptoms matching a textbook presentation, what technique of diagnosing is being used?
Template matching
If you know it when you see it, such as with acromegaly or Parkinson’s, what technique of diagnosing is being used?
Pattern recognition
When generating diagnostic hypotheses, besides clues, signs, and symptoms, what should you consider?
- Anatomy
- Referred pain
- Patient risk factors
- Etiologic categories
Which exams are done on every patient?
Vital signs
In what case are imaging and other tests needed?
If the diagnosis is still in doubt
What are the four most common causes of shoulder pain that present for treatment?
- Glenohumeral joint disorders
- Rotator cuff disorders
- Acromioclavicular joint disorders
- Glenohumeral joint instability
What are some glenohumeral joint disorders?
- Osteoarthritis
- Adhesive capsulitis
What are some rotator cuff disorders?
- Impingement syndrome
- Rotator cuff tear
What are some acromioclavicular joint disorders?
- Sprain/separation
- Osteoarthritis
What are some examples of glenohumeral joint instability?
- Dislocation
- Subluxation
- Micro-instability
