Shoulder Pathology

Question 1

Breast cancer

Answer 1

• palpate mass in breast tissue
• nipple discharge, retraction and local skin dimpling
• local rash
• mammogram results

red flag

Question 2

TOS

Answer 2

• forward (kyphotic) posture
• can’t sleep w/ pins and needles
• bad aching pain
• tender in suprascapular
• pain w/ lifting
• pos = NTPT, adson, wrist, roos and allen

Mechanism:
* compression of any of the two sites
* due to vascular or neuro compression
* common in middle-aged female or post/op

Question 3

Glenohumeral dislocation

Answer 3

• obvious acromion, flat shoulder and obvious head of humerus
• injured posture: IR and abducted, flexed elbow, pronated forearm, UE supported by opposite limb
• shart, stabbing pain, muscle guarding, head of humerus can be palpated anterior or inferior
• pos = apprehension test and sulcus sign
• need to check fracture in elderly

Mechanism:
* anterior is most common (90%)
* fall on outstretch hand

Question 4

Clavicular fracture

Answer 4

• can’t raise arm
• can see how weird it looks
• x-ray confirms

Mechanism:
* fall on shoulder
* direct blow to clavicle

Question 5

Acromioclavicular sprain

Answer 5

• pain and crepitus when touching and visual deformity
• (+) test: cross body adduction, O’brien’s, AC shear and sulcus/AC tx
• confirmed with bilateral A/P x-ray in ER with or w/o 10-15 lb weight
• need to r/o impingement

Mechanism:
* fall on the acromion
* FOOSH

Question 6

Labral tear

Answer 6

• pain w IR and adduction
• weakness w/ abduction and flexion
• sense of instability
• (+): speed test, O’brien’s, bicep load, pain provocation and crank
• confirmed with CT or MRI

Mechanism:
* FOOSH
* traction force on the shoulder or strong bicep contraction

Question 7

Subacromial bursitis

Answer 7

• swift onset of severe pain - mainly in deltoid insertion
• noncapsular end-feel with no limit in rotation
• busititis exist in isolation = passive ROM is painful
• (+) = hawkins/kennedy, neer’s and impingement relief
• subacromial bursa warm and TTP

• chronic irritation resulting from trauma or poor biomechanics
• can occur in middle-aged or older clients after lots of activity
• hx of tendonitis