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Differential Diagnosis > UE Differential Diagnosis & Screening > Flashcards

UE Differential Diagnosis & Screening Flashcards

1
Q

What are UE red flags?

A

History of cancer (breast & lung)
Heart disease (50+, postmenopausal women, family history)
Hypertension, diabetes, hyperlipidemia
Angina, myocardial infarction, pacemaker, coronary artery bypass graft
Trauma/assault/fall
Pulmonary tuberculosis (homeless, inmates, immunocompromised, IV drug use)
Fevers, diaphoresis, cough, hematuria, hematochezia
Increasing age
Alcoholism
Unexplained weight loss or weight gain
Pain changes with food intake, NSAID use
Knifelike, boring, deep aching, poorly localized

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2
Q

What are specific questions to ask with shoulder pain? (8)

A
  1. Where specifically….one finger point.
  2. Any trauma, falls, injury?
  3. Pain with activities?
  4. Neck pain, arm pain, chest pain, with breathing?
  5. Sensation? Numbness/Tingling/Weakness (N/T/W)?
  6. Swelling?
  7. Wake you at night? 24-hour behavior
  8. PMH/PSH
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3
Q

What are common MSK causes for shoulder pain?

A

Rotator cuff disease (tendinopathy, impingement, tear)
Acromioclavicular joint sprain
Adhesive capsulitis
Acute calcific tendonitis
Biceps tendinopathy, rupture
Subacromial bursitis
Referred pain from cervical spine
Contusion of shoulder and upper arm
Instability
Fracture of clavicle, scapula, proximal humerus, glenoid
Osteoarthritis to GH or AC joint
Avascular necrosis
Labral tear, SLAP lesion

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4
Q

What are less common MSK causes for shoulder pain?

A

Autonomic dysfunction
Brachial plexus injury, including stretch injuries (“stingers”)
Cervicalgia
Cervical radiculopathy (C4-7)
Charcot arthropathy
Cholecystitis
Contusion of shoulder and upper arm
Crystalline arthritis (gout)
Distal clavicular osteolysis
First rib fracture
Hemarthrosis
Hyperparathyroidism
Metastatic Disease
Osteoporosis with pathological fracture
Persistent somatoform pain disorder
Polymyalgia rheumatica
Pulmonary disease
Pyogenic arthritis
Rheumatoid arthritis
Shingles
Spinal accessory neuropathy
Sternoclavicular joint sprain
Suprascapular nerve entrapment
Thoracic outlet syndrome
Visceral pain (gall bladder, spleen)

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5
Q

What are associated signs and symptoms with subacromial pain syndrome, adhesive capsulitis, glenohumeral isntability, and other common shoulder dianoses?

A
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6
Q

What does OLD CARTS stand for in regards to taking an accurate patient history?

A

O-onset

L-location

D-duration

C-characteristic

A-aggracating

R-relieving

R-time

S-severity

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7
Q

Pain location over the deltoid would be a ____ ____ referral pattern.

A

rotator cuff

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8
Q

Pain over the clavical/upper trapezius would be a ____ ____ referral pattern.

A

AC joint

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9
Q

What are the red flags in the shoulder for cancer, infection, fracture, nerve injury, and visceral pathology (i.e. gallbladder)?

A
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10
Q

What are the possible systemic causes of shoulder pain form the neck, chest/trunk, abdomen, and systemic diseases?

A
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11
Q

Name/Describe the locations of pain referral patterns throughout the body.

A
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12
Q

How do you differentiate shoulder and cervical spine pathology?

A
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13
Q

If shoulder pain has a pleuritic component, the patient would experience or report what?

A

cough, reproduction, or increase in symptoms with respiratory movements

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14
Q

If shoulder pain is associated with GI, the patient would report what?

A

nausea, vomiting, abdominal pain or distention, belching, or diarrhea

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15
Q

If shoulder pain is related to cardiac, the patient would report what?

A

exacerbation by exertion unrelated to shoulder movement and coincident diaphoresis

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16
Q

If shoulder pain is associated with urologic signs and symptoms, the patient would report what?

A

blood in urine, painful or frequent urination, and unusual change in urine color

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17
Q

What are possible cardiac causes of shoulder pain? (4)

A

angina, bacterial endocarditis, pericarditis, endocarditis, or aortic aneurysm

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18
Q

If a patient has angina that is relieved with certain positions (i.e. sitting upright or quadruped), they might have [pericarditis/endocarditis]

A

pericarditis

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19
Q

If a patient has sudden and severe pain referred to their shoulder, they may have [aortic aneurysm/bacterial endocarditis]

A

aortic aneurysm

20
Q

If a patient has shoulder pain with shoulder warmth, tenderness, and redness along with other cardiac/pulmonary symptoms, the patient may have [aortic aneurysm/bacterial endocarditis]

A

bacterial endocarditis

21
Q

What are possible pulmonary causes of shoulder pain?

(3)

A

pleurisy, pneumothorax, and pancoast’s tumor

22
Q

If a patient has sharp, localized shoulder pain that is aggravated by respiration, coughing, or sneezing and also has a cough, fever, chills, or shallow breathing, the patient may have [pneumothorax/pleurisy]

A

pleurisy

23
Q

If the patient has dyspnea, sharp shoulder pain, weak and rapid pulse, decreased BP, and ipsilateral shoulder pain, the patient may have [pneumothorax/pleurisy]

A

pneumothorax

24
Q

If the patient has shoulder pain and brachial plexus involvement, the patient may have [pneumothorax/pancoast’s tumor]

A

pancoast’s tumor

25
Q

What are possible hepatic (liver) causes of shoulder pain? (4)

A

cholecystitis, liver abscess, hepatitis, or cirrhosis

26
Q

If a patient has hepatic (liver) related shoulder pain, they may have what associated signs and symptoms and what type of referral pattern?

A

nausea, dull abdominal aching, fullness, deep pain, constant fever, jaundice, fatigue, indigestion, weight loss, vomiting, dark urine

midback, scapula, right shoulder

27
Q

The liver, gallbladder, and common bile duct are the ______ organs.

A

biliary organs

28
Q

A gallbladder infection is referred to as what?

A

cholecystitis

29
Q

What are the breast related causes of shoulder pain? (4)

A

cancer, cysts, breast implants, and mastodynia

30
Q

What is the referral pattern for breast related shoulder pain?

A

chest, axilla, back, and shoulder

31
Q

Irritation of the upper dorsal intercostal nerve (associated with ovulatory cycles) is referred to as _________.

A

mastodynia

32
Q

What are the rheumatic causes of shoulder pain? (3)

A

rheumatoid arthritis, polymyalgia rheumatica, and polymyositis

33
Q

If a patient reports having malaise, fatigue, and other joint pain, they may have _______.

A

rheumatoid arthritis

34
Q

If a patient reports shoulder and pelvic girdle muscle pain, stiffness, fever, malaise, and weight loss, the patient may have [polymyositis/polymyalgia rhematica]

A

polymyalgia rheumatica

35
Q

If a patient reports or has apparent inflammation of numerous muscles, they may have [polymyositis/polymyalgia rheumatica]

A

polymyositis

36
Q

What two cancers are the most common types to metastasize to the shoulder?

A

breast and lung

37
Q

If a patient has a metastases to the shoulder, they may present with what on their exam? (3)

A

limited ROM, weakness, and pain

38
Q

What are some specific questions to ask for elbow pain? (8)

A
  1. Where specifically….one finger point.
  2. Any trauma, falls, injury?
  3. Pain with activities?
  4. Popping, snapping, catching?
  5. Swelling?
  6. Neck pain, arm pain, hand pain?
  7. Sensation? Numbness/Tingling/Weakness (N/T/W)?
  8. 24-hour behavior
39
Q

What are the MSK differential diagnoses for lateral elbow pain? (7)

A
  • Radiocapitellar joint osteoarthritis
  • Lateral collateral ligament injury
  • Radial neuropathy
  • Posterior interosseous nerve entrapment
  • Cervical radiculopathy
  • Painful ganglion cyst
  • Inflammatory arthritis or enthesitis
40
Q

What are the MSK differential diagnoses for medial elbow pain? (6)

A
  • Elbow joint osteoarthritis
  • Medial collateral ligament injury
  • Ulnar neuropathy
  • Cervical radiculopathy
  • Painful ganglion cyst
  • Inflammatory arthritis or enthesitis
41
Q

What are the MSK differential diagnoses for posterior elbow pain? (6)

A

olecranon bursitis, synovitis,, septic joint, fracture, metastatic disease, and scar

42
Q

What are the MSK differential diagnoses for anterior elbow pain? (6)

A
  • Distal biceps tendon rupture
  • Distal biceps tendinopathy
  • Intra-articular elbow pathology (OCD, loose body, capsular)
  • Elbow osteoarthritis
  • Median mononeuritis
  • Bicipitoradial bursitis
43
Q

What are some specific questions to ask with hand/wrist pain? (8)

A
  1. Where specifically….one finger point.
  2. Any trauma, falls, injury?
  3. Pain with activities?
  4. Popping, snapping, catching?
  5. Swelling or hand deformity?
  6. Neck pain, arm pain, hand pain?
  7. Sensation? Numbness/Tingling/Weakness (N/T/W)?
  8. 24-hour behavior
44
Q

What are the MSK differential diagnoses for ulnar sided wrist/hand pain? (8)

A
  • Extensor Carpi Ulnaris tendinopathy or subluxation
  • TFCC (Triangular Fibrocartilage Complex) injury
  • Carpal tunnel syndrome
  • Degenerative joint disease
  • Inflammatory arthritis
  • Chronic ligament instability
  • Diffuse tendinopathy
  • Infection
45
Q

What are the MSK differential diagnoses for radial sided wrist/hand pain? (8)

A
  • Scaphoid Fracture
  • Scapholunate instability
  • De Quervain’s Tenosynovitis
  • Degenerative joint disease (Carpal metacarpal or Radiocarpal)
  • Inflammatory arthritis
  • Chronic ligament instability
  • Diffuse tendinopathy
  • Infection
46
Q

What are the MSK differential diagnoses for numbness and volar sided wrist/hand pain? (11)

A
  • Carpal Tunnel Syndrome
  • Hook of the Hamate Fracture
  • Ulnar Neuropathy (Guyon’s canal Syndrome)
  • Cervical radiculopathy
  • Peripheral neuropathy
  • Brachial plexopathy
  • Ulnar neuropathy
  • Myelopathy
  • Brain lesion
  • Vascular causes
  • Thoracic outlet syndrome
47
Q

What are the MSK differential diagnoses for dorsal sided wrist/hand pain? (3)

A

ganglion cyst, capal boss (os styloideum), Kienbock’s disease of the lunate, intersection syndrome

Differential Diagnosis (7 decks)

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