UE medical screen

Question 1

Common referrals to (L) shoulder

Answer 1

• angina
• breast CA
• myocardial ischemia/infarction
• esophagus
• ruptured spleen
• pancreas
• ectopic pregnancy
• hepatomegaly/splenomegaly
• pulmonary: same side symptoms
• kidney: same side symptoms
• post op laprascopy (trapepd gas)

Question 2

Common referral to (R) shoulder

Answer 2

• angina
• breast CA: same side
• MI (less frequent)
• peptic ulcer
• acute cholecystitis
• liver abscess
• gallbladder
• liver: hepatitis, cirrhosis, tumor
• kidney: same side
• pulmonary: same side

Question 3

PMH factors for cardiac issues

Answer 3

• recent MI
• nausea
• fatigue
• sweating
• chest pain

Question 4

Rest MSK vs. Angina

Answer 4

• MSK lesion usually reduces with prolonged rest (>1hr)

- angina resolves 2-15 mins following activity

Question 5

Medical screening: pulmonary

Answer 5

• increased shoulder pain with deep inhalation
• recent onset of chest pain and SOB
• pressure on diaphragm (shoulder pain on same side as diaphragm pressure
• pain alleviated with lying on affected side (autosplinting)

Question 6

Medical screening: pancreas

Answer 6

• (L) shoulder pain
• chronic pancreatitis - pt reports vomiting/anorexia/nausea/weight loss
• attacks will be w/i a few hours to 2 weeks of onset
• aggravating factors: malaise
• relieving factors: walking, lying supine, alcohol, large meals

Question 7

Medical screening: hepatic/liver

Answer 7

• (R) shoulder pain and over region of liver
• pain in region of liver after exercise
• midback, scapula, (R) shoulder
• ROM unaffected
• local muscle tenderness not present
• dull aching sense of fullness
• constant pain

Question 8

Medical screening: gallbladder

Answer 8

• posterior medial, inter- or subscapular pain
• may be perceived as heartburn
• anterior 10th rib pain
• dull aching that progresses from mild to severe lasting 2-3 hours
• Aggravating: inhalation, eating, lying down, upper body movement

Question 9

Medical common: gynecologic

Answer 9

• proximal upper quarter pain
• posterior subcostal or costovertebral pain
• pressure from kidney on diaphragm may cause shoulder pain
• breast pain

Question 10

Medical screening: ectopic pregnancy

Answer 10

• shoulder pain is not only symptoms, but may be the 1st
• sudden, sharp, constant ipsilateral pain
• dizziness, light headed, fainting
• hx of: endometriosis, pelvic inflammatory disease, ruptured cysts, tubal ligation