Shoulder Pain

Question 1

Painful arc test

Answer 1

Tests for subacromial impingement and rotator cuff tendon injury

Highest positive LR of all rotator cuff maneuvers

Lowest negative LR of all rotator cuff maneuvers

Positive: shoulder pain from 60-120 deg

Question 2

VINDICATE for shoulder

Answer 2

Vascular
Inflammatory
Neoplastic
Degenerative/Deficiency
Idiopathic/Intoxication
Congenital
Autoimmune/Allergic
Traumatic
Endocrine

Question 3

Clavicle fx are most common in what population?

Answer 3

Kids and young adults

Question 4

Proximal humerus fx are most common in what population?

Answer 4

Elderly

Question 5

Scapular fx are most associated with what?

Answer 5

Blunt trauma

Question 6

What direction are glenohumeral dislocations most common?

Answer 6

Anterior

Question 7

Impingement syndrome

Answer 7

Sx resulting from compression of rotator cuff tendons and subacromial bursa

Question 8

Most rotator cuff injuries occur primarily in the ____ tendon

Answer 8

Supraspinatous

Question 9

___ are the most common cause of shoulder pain in primary care

Answer 9

Rotator cuff injuries

Question 10

Top causes of chronic shoulder pain

Answer 10

Rotator cuff disorders
Adhesive capsulitis
Shoulder instability
Shoulder arthritis

Question 11

Top causes of life threatening shoulder pain

Answer 11

Septic arthritis

Referred pain

Question 12

What is the best diagnostic tool for septic arthritis?

Answer 12

Aspiration of synovial fluid

Question 13

What is the most sensitive indicator of joint disease?

Answer 13

Evaluation of range of motion

Question 14

Apprehension test

Answer 14

Pt seated or supine, shoulder abducted to 90 deg

Stabilize shoulder with 1 hand, force arm into external rotation with other hand

+: pt apprehensive of repeat dislocation, glenohumeral instability

Question 15

Sulcus sign

Answer 15

Grab pt’s elbow and apply inferior traction

+: indentation appears in an area beneath the acromion, indicates glenohumeral instability

Question 16

Yergason’s test

Answer 16

Pt supinates and externally rotates against physician resistance

+: pain or tendon subluxation out of the groove, unstable bicipital

Question 17

Speed’s test

Answer 17

Pt’s arm flexed 50-90 deg at shoulder with hand supinated, resist at forearm while pt flexes shoulder

+: pain in bicipital groove indicates bicipital tendonitis of longhead biceps

Question 18

Empty Can test

Answer 18

Pt holds arms out and internally rotated, press down on forearms while pt resists

+: pain or weakness indicates supraspinatous pathology

Question 19

Drop-arm test

Answer 19

Pt abducts arm to 90 deg then slowly drops arm

+: arm will drop indicates full thickness tear of supraspinatus

Question 20

Neer Impingement

Answer 20

Stabilize pt’s shoulder. With arm pronated, passively flex shoulder to fully flexed position

+: pain indicates subacromial bursa or rotator cuff impingement

Question 21

Hawkins test

Answer 21

Flex shoulder and elbow to 90 deg, passively internally rotate

+ pain indicates rotator cuff or subacromial bursa impingement

Question 22

Liftoff test

Answer 22

Pt internally rotates arm behind back and internally rotates against physician resistance

+ weakness indicates subscapularis weakness

Question 23

Cross arm test

Answer 23

Pt passively adducts pt’s arm across their chest and rests pt’s hand on their opposite shoulder

+ test indicates AC joint pathology