Shoulder pain

Question 1

Shoulder pain:

How to take a MSK history?

Answer 1

How, Pain, Impacts =

1) Mechanism of Injury
2) Pain characterisation (when, where, quality, quantity, aggravating, alleviating, belief of cause)
3) Dysfunction due to condition

Question 2

Shoulder pain:

Redflags in shoulder pain?

Answer 2

• Bilateral - ?PMR/GCA
• disproportional to signs - ?acute compartment syndrome
• nerve or vascular compromise
• joint swelling/heat - ?septic arthritis
• cardiac/pleural/intraperitoneal referred pain - ?MI, PE, diaphragmatic irritation

Question 3

Shoulder pain:

Categorisation of pathology?

Answer 3

• Intra-articular or Extra-articular

- Static or Dynamic

Question 4

Shoulder pain:

Prognosis of shoulder pain?

Answer 4

Recovery time
1 month - 23%
3 months - 44%
6 months - 50%
12 months - 60%

Question 5

Shoulder pain:

Principles of examination?

Answer 5

Look
Feel - supraspinatus, bicep tendon
Move - active/passive

check neck and elbow (joints above and below)

Tests worth doing:
Empty can test
(extended arms, shoulder flexed to 90 degrees, thumbs pointing down and resisted flexion) = (100% specific for supraspinatus tear if acute NOT chronic)

Hawkins
(internal rotation of shoulder in flexed position with elbow at 90 degrees, performed in varying angle of adduction to abduction) = 90% sensitive, 35% specific for impingement

Active Compression test
(1 - internal rotation of shoulder, flexed to 90 degrees, 10 degrees of adduction with arm extended - resisted flexion - pain = 90% specific, 41% sensitive for Acromioclavicular joint sprain

2 - external rotation of shoulder flexed to 90 degrees, 10 degrees of adduction with arm extended - resisted flexion- if ACJ pain should ease)

Question 6

Shoulder pain:

Common conditions to know?

Answer 6

Supraspinatus impingement

• MOA - poor stabilising muscle tone or arthritic/hypertrophic anatomy changes
• test with Hawkins test
• pain is overhead or lateral compression (bed)

Anterior joint instability

• MOA - heavy loads or repetitive stress (in shoulder extension)
• pain is aching, associated with clicking, lateral compression (bed) can have paraesthesia associated

Rotator cuff tears

• MOA - tendonopathy that progresses to tears or acute shearing force
• test with empty can test
• functional impact post injury and timeline of injury determines recruitment of other muscles to accomodate dysfunction

ACJ sprains or osteoarthritis
-test with active compression test