Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PCM-exam 1 + 2 > Shoulder Pain > Flashcards

Shoulder Pain Flashcards

1
Q

Joint Exam

A
  • Inspection
  • Palpation
  • Range of Motion
  • Specialty testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Extremity Exam

A
  • Inspection
  • Palpation
  • Range of Motion
  • Specialty testing
  • Reflexes
  • Assess Neurovascular status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Shoulder Pain

A

• 3rd most common musculoskeletal complaint
• The only joint in the human body where tendons (rotator cuff) pass between bones (acromion and humerus)
– great flexibility
– Great Susceptibility to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inspection

A 
• Look at the joint.
• Look at the extremity.
• Compare them to the opposite side
• What do you see? 
– Splinting?
– Symmetric?
 – Color?
– Scars?
– Abrasions? 
– Injuries?
– Swelling?
– Ecchymosis? 
– Deformity?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Palpation

A

• Is the joint warm when compared to the opposite joint?
• Is there tenderness to palpation? – Where is the tenderness?
• Is there edema?
• Is there an Effusion?
• What hurts?
– The entire joint?
– Only one area?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Range of Motion

A 
(A) Flexion.
(B) Extension.
(C) Abduction.
(D) Adduction.
(E) Internal rotation.
(F) External rotation.
(G) Horizontal abduction. (H) Horizontal adduction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Specialty Test for Shoulder

A 
• Tests for subacromial impingement and rotator cuff tendon injury
– Painful Arc test
– Neer impingement sign
– Hawkins impingement sign
– Yergason sign
– Empty Can test
– Drop Arm test
• Tests for Acromioclavicular joint/ligament injury
– Cross arm test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Painful Arc Test

A

• Tests for subacromial impingement and rotator cuff tendon injury
• Positive LR = 3.7 / Negative LR = .36
• Highest positive LR of all Rotator
cuff maneuvers
• Lowest Negative LR of all rotator cuff maneuvers
• A positive test is shoulder pain from 60 to 120 degrees
– indicates subacromial impingement and/or rotator cuff injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do I Evaluate a Patient with Joint Pain?

A
  • Determine stability of patient and stabilize if needed
  • Develop and Work Through Differential Diagnosis
  • Assessment and Plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DDX: Causes of Shoulder Pain

A
  • Brachial plexus injury •
  • Fracture •
  • Bursitis •
  • Cervical radiculopathy •
  • Glenohumeral dislocation •
  • Frozen shoulder (Adhesive Capsulitis) •
  • Referred pain •
  • Impingement •
  • Osteoarthritis….
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Shoulder Pain–> Traumatic

A
  1. Bone (fractures, dislocations)
  2. Soft Tissues (myofascial, rotator cuff…)
  3. Joint (cartilage, joint capsule…)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Shoulder Pain–> Atraumatic

A
  1. Intrinsic-the shoulder as a whole (overuse, shoulder instability, subacromial bursitis…)
  2. Extrinsic/Referred - no shoulder pathology at all with normal shoulder exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fractures

A
  1. Clavicle Fractures (mainly children)
  2. Proximal Humeral Fractures (mainly the elderly)
  3. Scapular Fracture (associated with blunt trauma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glenohumeral Dislocation

A 
• 50 percent of all major joint dislocations
• 3 types
– Anterior dislocation
• most common
• accounting for 95 to 97
percent of cases
– Posterior dislocation • 2 to 4 percent
– Inferior dislocation (luxatio erecta, which means "to place upward")
• 0.5 percent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acromioclavicular Joint Injuries

A

• usually occurs from direct trauma to the superior or lateral aspect of the shoulder (acromion) with the arm adducted, such as a direct blow or falling onto the shoulder
• Physical Exam
-tenderness directly over the AC joint, possibly associated with deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rotator Cuff Injuries

A

• Physical exam
– tenderness over the affected musculature or focal subacromial tenderness at the lateral or posterior- lateral border of the acromion
– the location of the rotator cuff deep to the deltoid makes palpation difficult and unreliable.

17
Q

Rotator Cuff Diagnostics

A
  • X-rays are not helpful

- MRI/Ultrasound are the tests of choice

18
Q

Rotator Cuff Treatment

A
  • Initial management is rest, ice, physical therapy

- Later management: orthopedic referral (if initial shows now improvement/if patient is suspect of a tear)

19
Q

Impingement Syndrome

A

-Rotator Cuff
– symptoms resulting from compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process

20
Q

Tendinopathy

A

-Rotator Cuff
– chronic injury to the supraspinatus (abduction) and/or infraspinatus (external rotation) tendons.
– develops as a consequence of repetitive activity, generally at or above shoulder height, which leads to tendon degeneration and microvascular insult.

21
Q

Tendon Injury

A

-Rotator Cuff
– Sprain or Tear (partial or complete)
– occur as the end result of chronic subacromial impingement, progressive tendon degeneration, traumatic injury, or a combination of these factors.
– Most injuries occur primarily in the supraspinatus tendon

22
Q

Extrinsic (referred) Causes of shoulder pain

A 
• Neurologic
– Cervical radiculopathy (C5-C6)
– Brachial plexus lesions
– Herpes Zoster
– Spinal cord lesion
– Cervical Spine DJD
– Thoracic Outlet Syndrome
• Cardiovascular
– Acute Myocardial Infarction
 – Axillary vein thrombosis
• Abdominal
– Hepatobiliary disease
– Diaphragmatic irritation
• Intraperitoneal blood, perforated viscus
• Pulmonary
– Upper lobe Pneumonia
– Apical lung tumor
– Pulmonary Embolism
23
Q

Intrinsic Causes of Shoulder Pain

A
  • Overuse injuries
  • Shoulder instability
  • Rotator cuff tendinopathy or impingement syndrome
  • Subarcomial bursitis
  • Synovitis
  • Adhesive capsulitis
  • Bicepital tendinitis
  • Osteoarthritis
  • Myofascial pain
  • Septic arthritis
  • Gout/pseudo gout
24
Q

Top Causes of Acute Shoulder Pain

A 
• Rotator cuff injuries
– the most common cause of
shoulder pain in primary care
• Fractures/dislocations – Fractures
• clavicle and proximal humerus • Dislocations
– glenohumeral joint
• Acromioclavicular joint injuries
– Sprains, tears • Myofascial injury
25
Q

Top Causes of Chronic Shoulder Pain

A
  • Rotator cuff disorders
  • Adhesive capsulitis
  • Shoulder Instability
  • Shoulder Arthritis
26
Q

Top Causes of Life Threatening Shoulder Pain

A 
• Septic Arthritis
• Referred Pain 
– Acute MI
– Intraperitoneal Hemorrhage
– Lung pathology
27
Q

Septic Arthritis is more frequent in…

A 
– Age >80 years, Diabetes mellitus
– Rheumatoid arthritis
– Presence of prosthetic joint
– Recent joint surgery
– Skin infection
– Intravenous drug abuse, alcoholism
– Prior intraarticular corticosteroid injection
28
Q

How often is the knee involved in septic arthritis?

A

more than 50% of the time

– wrists, ankles, and hips are also

29
Q

Septic Arthritis Symptoms

A
  • Joint is erythematous, swollen, warm and painful to the touch
  • Active and passive ROM very limited
30
Q

Treatments for Septic Arthritis

A

• Treatment:
– Antibiotics; broad spectrum preferably after aspiration of synovial fluid and blood cultures
– Surgical washout of joint

31
Q

Septic Arthritis Diagnostic

A
  • plain film x-rays will likely be normal or show an effusion
  • Lab: elevated CBC, ESR, and CRP; synovial fluid will show WBC’s and bacteria
  • Aspiration of Synovial Fluid*

PCM-exam 1 + 2 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions