Shoulder pain and its causes

Question 1

adhesive capsulitis

Answer 1

frozen shoulder syndrome chronic inflammation and fibrosis and contracture of joint capsule

Question 2

Treatment of adhesive capsulitis

Answer 2

more stiffness than pain with inability to reach objects or rotate shoulder >50% reduction in PROM or AROM Self limited condition and responds to conservative management with Stretching exercises as treatment of choice.

Question 3

pain with abduction, external rotation of shoulder subacromial tenderness and normal ROM positive impingement tests (neer’s and hawkins), think:

Answer 3

rotator cuff impingement or tendinopathy

Question 4

similar presentation to rotator cuff tendinopathy but with weakness with abduction and external rotation age >40 yrs old

Answer 4

rotator cuff tear

Question 5

stiffness and pain and decreased passive and active ROM

Answer 5

adhesive capsulitis (frozen shoulder)

Question 6

anterior shoulder pain, pain with lifting, carrying or overhead reaching and weakness is less common

Answer 6

biceps tendinopathy or rupture

Question 7

gradual onset of anterior or DEEP shoulder pain and decreased active and passive abduction or external rotation. caused by trauma and generally uncommon

Answer 7

glenohumoral osteoarthritis.

Question 8

Milwaukee shoulder

Answer 8

basic calcium phosphate deposition disease (similar to CPPD) that results in subacute shoulder arthropathy and large hemorrhagic effusion. This destroys the joint involving the glenohumoral joint and rotator cuff.

Question 9

XR of a Milwaukee shoulder

Answer 9

perarticular calcification and destructive arthritis. MRI can help delineate pathology better. Synovial fluid is hemorrhagic and has basic calcium phosphate crystals that are not seen under polarized microscopy.

Question 10

diagnosis of milwaukee shoulder

Answer 10

clinical diagnosis as cannot evaluate fluid for the calcium phosphate crystals.

Question 11

synovial fluid analysis of osteoarthritis is

Answer 11

non inflammatory and WBC<2000

Question 12

osteosarcoma is seen in

Answer 12

kids and adolescents and see a soft tissue mass that is palpable

Question 13

Gout and Pseudogout are two separate conditions. Do they present with joint destruction and hemorrhagic effusions on joint aspiration?

Answer 13

no. rarely see bloody effusion or synovial fluid.

Question 14

smoker and shoulder pain and paresthesias in their hadn

Answer 14

pancoast tumor, get a CXR

Question 15

manifestations of superior pulmonary sulcus tumor or pancoast tumor?

Answer 15

shoulder pain, horner’s syndrome (invasion of paravertebral sympathetic chain, stellate ganglion) and see neurological symptoms (invasion of C8-T2) with weakness, atrophy of intrinsic hand muscles, pain and paresthesias of 4th 5th digits and medial arm/forearm supraclavicular LAD weight loss

Question 16

shoulder pain

Answer 16

Question 17

when do people get rotator cuff tears?

Answer 17

seen in people >40 yrs after a fall braced by an outstretched arm.

pain in lateral deltoid that is worsened by raising arm or overhead activity and pain and external rotation

positive drop arm test

weakness in external rotation

MRI and MSK u/s can accurately diagnose the rotator cuff tear. Treatment involves surgery and best results occur within 6 weeks of injury.

Question 18

Shoulder impingement

Answer 18

Start with XR to rule out arthritis

CT shoulder next to rule out masses

MRI shoulder will make the diagnosis. it’s preferred

can treat with cortisone shot in the hsoulder bursa to diagnose impingement if it’s effective in relieving pain.

Question 19

how to treat a neurogenic thoracic outlet syndrome?

Answer 19

thoracic outlet syndrome 1st line tx

physical therapy - aimed at shoulder girdle muscle strengthening and improving posture

Question 20

what is thoracic outlet syndrome?

Answer 20

compression of brachial plexus, subclavian artery, subclavian vein as a these structures pass through the thoracic outlet.

3 subtypes: derived by the structure involved: nerve, artery, vein

neurogenic TOS is the most common

compression of brachial plexus nerve roots as they exit the triangle formed by the 1st rib and the scalenus anticus and medius muscles.

Question 21

symptoms of thoracic outlet syndrome?

Answer 21

parethesias, pain, that worsen with activties that involve continued use of arm or hand especially those that include elevation of the arm.

no abnormal neurogenic findings

EMG won’t see anything

1st line therapy for neurogenic TOS includes improving posture and strengthening should girdle muscles.