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Flashcards in Approach to Shoulder Pain Deck (30)
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1
Q

Most common extrinsic cause of shoulder apin and others

A

Cervical spine abnormalities

Cardiac, lung/pleura, intraabdominal, neurologic

2
Q

Atrophy of muscles above and below scap spine

Superior porminance of distal clavical

Medial porm of SC joint

A

Chornic supraspinatus - above

Chronic infraspinatus - below

Dislocation

Dislocation

3
Q

Tenderness over

Clavicle
AC joint
Inferior to AC joint
Bicipital groove
Sternoclavicular
A

Fracture

Separation or arthritis

Aubacromial burisits

Bicipital tendinopathy or tear

Fracture

4
Q

Active vs. passive ROM

A

Active only - RC tenidnopathy, biceps tendinopathy, or subacromial burisits

Both - glenohumeroal joint (RA or frozen) or AC sep/OA

5
Q

Abduction between 60 and 120 (painful arc)
Abduction between 120 and 180
Ext rotation pain
Int rotation pain

A

RC dz
AC joint
Teres minor or infraspinatus
Subscapularis

6
Q

Jobe test

A

PLace arm in 90 of abduction, 30 degrees of forward flexion and internal rotation..ask to resist dowward

Pain or weakness is RC tendinopathy or tear (supraspinatus)

7
Q

Neer impingeent sign

A

One hand stabilizes scap while other flexes with patient’s straight arm

Pain suggests RC tendinopathy or impingmeent syndrome

8
Q

Hawkins Kennedy test

A

One hand stabilizes scap while other hand internally roates the part flexed 90 degrees at elbow

Pain or discomfort is RC tenidnopathy or impingement syndrome

9
Q

RC injury

A

Traumatic, overuse, or combo

Most common supraspinatus

Shoulder weakness and anterolateral pain worse at night and with overhead motion

Pain between 60 and 120 abduction and inability to abduct beyond 90

Weakness in empty can abduction

10
Q

Labral tear

A

Superior labrum anterior to posterior tear is common if throwing

Usually acute from falling on outstreatched or direct blow

Decline in throwing function or anterior pain in shoulder

11
Q

AC separation

A

Direct trauam to superior or laterla shoulder or flal on outstretched

Rupture the AC ligament

Pain loalized worse with apssive adduction across the body

X-ray will confirm

12
Q

Biceps tendon tear

A

Acute onset after lifting

Hx of anterior shoulder pain aggravated by carryning or overhead reaching

Tenderess of bicipital groove, lump above the antecubital fossa or weakness of elbow flexion

13
Q

GH disclocation

A

Anterior dislocation from abducted, externally roated and extedned arm (blocking a shot)

Holds arm abducted and extenrally roates and resists GH movement

Loss of normal shoulder appearance with prominent acrominon

Axillary nerve injured so loss of sensation just distal to deltoid

14
Q

Transient brachial plexopathy

A

Actue trauamtic contact ot neck or aneterior shoulder

Sfeeling in supraclvicular area raditating dwon arm in cricumferential, non dr mpattern

Motor deficits of C5-C6 (deltoid and supraspinatus)…weakness of abduction and/or empty can shoulder abduction

15
Q

Clavicle fracture

A

Fall onto shoulder

Middle thrid of the bone…followed by distal

Localized pain over clavicle worse with arm movement

May have ecchymosis or hematoma

Point tenderenss/crepitus

Most nondisplaced tx with immobilization

16
Q

RC tendinopathy

A

Older adolescents and young adults in throwing sports

impingement narrowing between acromon and RC tendons…acromion rubs against tendons and subacromial bursa

Most commonly supraspinatus

Shoulder weakness and anterolateral hsoulder pain worse at night and with overhead

Pain with active abduction between 60 and 120 and pain with empty can abduction

17
Q

Proximal humeral epiphysiolysis

A

Little lead shoulder between 10 and 15

Torque of humerous leadsto microtrauam and irritatin of proximal humeral physis…widing of the physis

Worsening lateral shoulder pain

18
Q

GH instability

A

Young women with poor muscular development or atheletes iwht constant overhead throwing

Giving way or looseness of the joint

Anterior instability and wors ewith shoulder abduction and rotation

Exam may show increased ROM of the GH joint and patient apprehension with extreme abduction and extenral rotation

19
Q

Labral tear

A

SLAP is most common

Clikc when parm placed in throwing position

Click on any manuever that compresses and rotates the head into the glenoid

MRI needed

20
Q

Biceps tendinopathy

A

Uncmmon by inteself but accompanies GH instability in younger

Anteriro shoulder radiating to distal biceps with tenderness of bicipital groove

21
Q

RC injury older

A

Stillsame sx but may have acute onset

22
Q

AC joint separation older

A

Same as in younger

23
Q

Biceps tendon tear older

A

Degerative tendinosis plus actue injry

Most have hx of anterior shoulder pain
Sudden painful extension of a flexed elbow after full contraction

24
Q

Pseudogout

A

Think sudden onset of shouder pain and another joint

25
Q

Adhesive capsulitis

A

Gradual development of limited active and passive motion

Diabetes, thyroid, prolonged immobilization ad shoulder injuries

Inflammation of joint capsule followed by fibrosis of synovial lining

40-70 y/o

Initial inflam phase with diffuse pain worse at night and with sitffnesss

Fibrotic second phase with loss of motion 4-12 months

On exam, patients have limited ROM in multiple planes

PT and intra-artc GCs

26
Q

RC tendinopathy

A

Most common cause of recurrent pain in older adults

Looks like a tear

27
Q

Subacromial burisits

A

Supraspinatus tendon passes through space between acromion and subacromial bursa…inflammation of bursa rubs tendon against acromion and subacromial bursa

identical to RC tendinopathy

28
Q

Ac joint OA

A

Pain localized worse with passive adduction across the body

Xpray can confirm with typical OA findings

29
Q

RA

A

Symmetric hsoulder involement with small joints of hands

30
Q

PMR

A

Over 50

Symmetric pain with lots of morning stifness

Elevated ESR and low-dose GC response