Shoulder pain

Question 1

Rotator cuff

Answer 1

• Chronic overuse of tendon
• Inflammation and acute trauma from repetitive stress
• Collagen degeneration, thickens tendon and loss of tensile strength
  S&S:
• Pain and weakness on abduction
• Limited ROM
• Difficulty with overhead motions
• Tenderness at site- localized pain can radiate to bicep
• Possible deformity
  DX:
• Neer’s: to provoke impingement of tendon: raise arm straight up- pain: +
• Hawkin’s: Provokes impingement. Arms 90 degrees and move it toward pt
• Apley scratch: To test for ROM. Adduct and internal rotation. Abduct and external rotation
• Empty can test: Tests for strength/weakness. Hold can and resist pressure both down and up
  TX:
• Rest
• Exercises: wall climbing, pendulum
• Injections
• Don’t immobilize
• NSAIDs for pain NOT for inflammation

Question 2

Bicep tendinopathy

Answer 2

• Pain with palpation at the bicipital groove from trauma
  DX:
• Yergason test: palpate the groove while pt supinates and external rotates– snapping at the groove
  TX:
• Same

Question 3

Rotator cuff tear

Answer 3

• Trauma from repetitive stress
  S&S:
• Inability to perform any impingement test
• Inability to LIFT arm- nothing overhead
• Pain, weakness with abduction
• Limited ROM
• Tenderness at site
  DX:
• Positive drop arm test: Bring arms up and lower them slowly. With tear, pt drops arm
  TX:
• Refer to ortho

Question 4

Adhesive capsulitis

“Frozen shoulder”

Answer 4

- Trauma from repetitive stress
S&S:
- Significant loss of ROM
- Can't move shoulder at all
TX:
- Ortho