Case #1

Question 1

List Problems by Process (for DD)

Answer 1

Vascular, Infectious, Trauma, Autoimmune, Metabolic, Iatrogenic/Idiopathic/Intox, Neoplastic

Congenital, Degenerative, Endocrine

Question 2

What is frozen shoulder?

Answer 2

Adhesive capsulitis

Question 3

Who tears their supraspinatus?

Answer 3

Middle aged Male

Trauma or Exertion

Question 4

Deferred pain indicates what?

Answer 4

Partial Tear (leaves time for swelling to make pathway smaller)

Question 5

Bones of shoulder joint? (3)

Answer 5

Clavicle, Scapula, Proximal Humerus

Question 6

Articular Surfaces in shoulder (4)

Answer 6

Sternoclavicular
Acromioclavicular
Glenohumeral (the main one)
Scapulothoracic

Question 7

SITS muscles

Answer 7

Supraspinatus
Infraspinatus
Teres Minor

Subscapularis

Question 8

Main muscles of arm flexion (2)

Answer 8

Pectoralis

Deltoid

Question 9

Main muscle of arm extension

Answer 9

Deltoid (teres major helps)

Question 10

Main muscle of arm abduction

Answer 10

Deltoid (supra helps)

Question 11

Main muscle of arm adduction?

Answer 11

Pectoralis, Lat (Sub, Infra, and Teres)

Question 12

Main muscle of medial rotation? Lateral?

Answer 12

Medial – Subscap

Lat – Infra

Question 13

Tensors of the articular capsule?

Answer 13

SITS

Question 14

Muscle to resist downward dislocation?

Answer 14

Deltoid

Question 15

What is the painful arc sign?

What does a positive suggest?

Answer 15

Pain with active abduction beyond 90 degrees

Rotator Cuff Tendinopathy

Question 16

What is a Neer test?

What are you looking for?

Answer 16

Passively flex glenohumeral
No shrugging

Assess Impingement

Question 17

What is a Hawkins Kennedy test?

Answer 17

Clinician internally rotates shoulder with elbow up
Pain = Positive

Positive = Likely supraspinatus tendon (possibly teres or infra)

Question 18

What is a Jobe’s test?

Answer 18

Straight arm 90 deg. up, 30 deg forward
Internally rotates shoulder (like emptying can)
Clinician resists movement

Pain - weakness = tendinopathy
Pain + weakness = Tear

Question 19

What does assessing external rotation strength look at?

Answer 19

Infraspinatus and Teres Minor

Question 20

What do you look for in push off tests?

Answer 20

Hand behind back push against resistant

Subscapularis

Question 21

Three imaging studies possibly used in shoulder pain?

Answer 21

X-ray/CT – Bones
MRI – Soft Tissue
Ultrasound

Question 22

What do you do if acute arthritis is suspected?

Answer 22

Arthrocentesis

Question 23

What traits should you look to to distinguish between shoulder disorders?

Answer 23

Inflammation, Number of Joints, Site of Involvement

Question 24

Examples of Intrinsic Shoulder Issues. (7)

Answer 24

Trauma
Acute Arthritis
Bursitis
Capsulitis
Bicipital tendonitis
Rotator Cuff Tendonopathy (w/impingement)
Myofascial Pain

Question 25

Examples of Extrinsic Shoulder Issues?

Answer 25

Neurologic Diaphragmatic Irritation Cardiovascular Thoracic

Question 26

Difference between tendinitis and tendinosis

Answer 26

Tendinitis -- Inflammation of Tendons from microtears | Tendinosis -- Degeneration of Tendons from chronic overuse

Question 27

Why is tendinosis difficult to detect?

Answer 27

No accompanying inflammation

Question 28

What is tendonopathy?

Answer 28

Tendon thickening and chronic, localized tendon pain

Question 29

Initial treatment for shoulder pain?

Answer 29

Rest Analgesics/Anti-inflammatory medications Pendulum Exercises

Question 30

Later treatment for shoulder pain?

Answer 30

Strengthening Exercises/Physical Therapy Return to Normal Activities Surgery if a complete tear

Question 31

What is anchoring bias?

Answer 31

The tendency to place too much weight on a single piece of information acquired early in the data acquisition process.

Question 32

Five steps in Diff Diag?

Answer 32

``` Acquire Data Identify Key Features Create a Representation Adopt a Framework Apply Features to Framework ```

Question 33

In CBC, HgB is a measure of...

Answer 33

Hemoglobin

Question 34

Hct =

Answer 34

Hematocrit

Question 35

MCV=

Answer 35

Mean Corpuscular Volume (Size of RBC)

Question 36

MCHC=

Answer 36

Mean Corpuscular Hemoglobin Concentration

Question 37

SEGS=

Answer 37

Neutrophils