Shoulder pain Flashcards
Painful arc test
- Tests for subacromial impingement and rotator cuff tendon injury.
- Highest positive LR and lowest negative LR of all rotator cuff maneuvers.
- (+) test is pain between 60 and 120 degrees.
Traumatic causes of shoulder pain
Bone: Fracture of clavicle/proximal humerus, or dislocation of glenohumeral joint (usually occur in anterior direction)
Soft tissue: AC ligament, rotator cuff, labral tear.
Intra-arcticular: Labrum tear, hemarthrosis (blood in joint), damage to joint capsule.
Acromioclavicular joint injury
Result of direct trauma to the superior or lateral aspect of the shoulder (acromion) with the arm adducted.
The classic example is Aaron Rodgers getting tackled by Anthony Barr. Usually will have a noticeable step-off.
Can range from AC sprain –> AC tear –> AC + coracoclavicular ligament tear.
Rotator cuff pathology
Supraspinatus, Infraspinatus, Teres minor and Subscapularis.
Most injuries involve the supraspinatus tendon.
Can see impingement (compression of the tendon and the subacromial bursa between the greater tubercle and the lateral edge of the acromion.
Tendinopathy
Top causes of acute shoulder pain
1) Rotator cuff injury
2) Fracture/dislocation
3) AC joint
4) Myofascial injury
Top causes of chronic shoulder pain (6+ months)
1) Rotator cuff disorder
2) Adhesive capsulitis, resulting from multiple dislocations.
3) Shoulder instability
4) Arthritis
Top causes of life threatening shoulder pain
1) MI
2) Septic arthritis
3) Intraperitoneal hemorrhage
4) Lung pathology (PE…)
GH instability special tests
Apprehension test –> (+) test is apprehension over repeat dislocation.
Sulcus sign –> (+) test is an indent (sulcus) that appears near the acromion.
Bicipital tendon pathology
Yergason’s test –> Arm is flexed to 90. Physician palpates bicipital groove, while the other hand holds the wrist. The patient now will supinate and externally rotate against resistance. (+) test is pain at the bicipital groove.
Speed’s test –> arm is flexed at 50-90. Resist at forearm while the patient flexes the shoulder. (+) test is pain at the bicipital groove.
Rotator cuff pathology (tear)
Empty can test –> (+) test is pain or weakness. Indicates supraspinatus tear.
Drop arm test –> (+) test is dropping (adducting) the arm too quickly after a tap on the wrist.
Rotator cuff impingement
Painful arc test –> (+) test is pain between 60-120 degrees of shoulder abduction. Suggests rotator cuff or subacromial bursa impingement.
Neer impingement –> Stabilize patient’s shoulder, flex arm and “pour beer out”. (+) test is pain. Suggests rotator cuff or subacromial bursa impingement.
Hawkins test –> Flex shoulder and elbow to 90, then passively induce internal rotation. (+) test is pain. Suggests rotator cuff or subacromial bursa impingement.
Subscapularis specialty test
Lift off test –> (+) test shows weakness or inability to resist.
AC joint pathology
Cross Arm test –> (+) test is pain in AC joint with end range horizontal adduction. Dab on ‘em.
Which joint in the human body has tendons that pass between bone?
Rotator cuff tendons go between acromion and humerus. Provides with great flexibility, but also very prone to injury/impingement.
What is the most sensitive indicator of joint disease
ROM
