Lecture 8: Shoulder Complaint Flashcards by Aman Kankaria

What makes the shoulder joint special?

Rotator cuff tendons pass between bones (acromion and humerus)

Pros: great flexibility
more susceptible to injury

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What bones make up shoulder?

Clavicle
Scapula (Acromion)
Humerus

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What are the steps of a shoulder joint exam?

Inspection
Palpation
Range of Motion
Speciality Testing

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What is Painful Arc Test?

Test for subacromial impingement and rotator cuff tendon injury
-Positive if there is pain from 60-120 degrees

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What is the first step in order to diagnose shoulder pain?

Check if it is traumatic or atraumatic

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What can be possibly injured in traumatic shoulder pain?

Bones: fractures (clavicle or proximal humerus) or dislocation (glenohumeral)
Soft Tissue: Myofascial, Rotator Cuff (tendon injuries), Acromial clavicular ligament injury
Joints: cartilage, hemarthrosis, joint capsule

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What can can cause atraumatic shoulder pain?

Extrinsic: referred pain (e.g. heart attack)
Intrinsic: Overuse injuries, shoulder instability, septic arthritis, etc

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Where are possible fractures or dislocations in shoulder?

Fractures: clavicle (mostly in kids), proximal humerus (mostly in old people), scapula (blunt trauma)
Dislocations: Glenohumeral (most often anterior)

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Where are possible soft tissue injuries in shoulder?

Ligamentous injuries (ex Acromial Clavicular ligament)

- Tendon injuries (rotator cuff)

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What is most common cause for acromioclavicular joint injuries?

Direct blow or falling onto shoulder

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What muscles make up Rotator Cuff?

Supraspinatus (Tendon of Supraspinatus M. most injured)
Infraspinatus
Teres Minor M.
Subscapularis M.

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What are common ways to injure Rotator Cuff muscle?

Repetitive overhead activity (work or sports)

Impingement syndrome: compression of Rotator cuff tendons
Tendon Injury: sprain or tear
Tendinopathy: chronic injury to tendons

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What are some extrinsic causes of shoulder pain?

Neurologic: cervical radiculopathy, brachial plexus, herpes zoster, thoracic outlet syndrome, etc

Abdominal: Hepatobiliary disease, diaphragmatic irritation

Cardiovascular: Acute MI, thrombosis

Pulmonary: Pneumonia, lung tumor, pulmonary embolism

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What are intrinsic causes of shoulder pain?

Overuse
Shoulder instability
Rotator Cuff issues
Bursitis
Synovitis
many more

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What are most common acute reasons for shoulder pain?

Rotator Cuff Injuries
Clavicle and Proximal Humerus Fractions
Glenohumeral Joint Dislocations
Acromioclavicular joint injuries
Myofascial injury

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What are most common life threatening reasons for shoulder pain?

Septic Arthritis

- Referred pain from MI, Lung Pathology, Intraperitoneal Hemorrhage

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Joint vs extremity exam

joint: inspection: palpation, rom, speciality testing

exremity: palpation, rom, speciality testing, nerovascular status
- neuro: reflex and motor/sensory
- vascular: pulses and cap refill

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Glenohumeal dislocation is ___ of all major joint dislocations?

50%

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What are the three types of glenohumeral dislocation

anterior (most common)
posterior (2-4 percent)
inferior: luaxio erecta: hand is placed upwards looks like ur raisng your hand (.5%)

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AC sepearation called what

step off

What tendon is most commonly injured in the rotator cuff?

supraspinatus

Always document what?

Patient is neurovacularly intact

If the patient is atruamatic what should you order first?

an ekg

After a fall what should you ask?

did you loose consciousness? What did you fall on?

Arm flextion

180 degrees choracobrachialis and anterior deltoids

arm extension

60 degrees latissimus dorsi and teres major

Arm abduction

180 degrees deltoids and supraspinatus

arm horiziontal adduction

pectoralis major and latssimus dorsi (40-50 or 130-140)

arm horiztional abduction

suprspinatus and mid delts 130-145 or 40-55

arm external rotation

infraspinatus and teres minor 90

arm internal rotation

subscaupularis and pec minor 90

Apprehension test

- patient is seated - shoulder abducted to 90 and elbow is flexed to 90 - block linkage and then force arm into extenral rotation + test: patient apprehensive of repeat dislocation indecates glenohumearl instability

Empty can test

- flex patient shoulders to 90, while horiztonally abducting them to 45. - internally rotate both arms so tumbs are pointing down - press down on forearms while patient resisits + test: pain/ weakness indicates rotator cuff pathology (supraspinatus)

drop arm test

- abduct arm to 90 and tell them to slowly drop arm - positive test: arm will drop or gentle wrist tap will cause arm to drop - indicates full thickness tear of suprapinatus

Painful arc test

- patient abducts arm starting at their side - positive test: pain is present within 60-120 degress of shoulder abduction - indicates subacromial impigment / rotator cuff injury

neer impingment

-stabalize the patients shoulder with forearm pronated. Passivley flex the shoulder to fully flexed position. + test is pain indicates subacromial bursa or rotator cuff impingment

Hawkins test

flex shoulder to 90 degrees, flex elbow to 90 degrees and passivley rotate the humeurs into internal rotation. + test: pain indicates rotator cuff or sub acromial bursa impingment

cross arm test

adducts patients arm across their chest and rest it on oppsite shoulder + test: pain in ac joint with end range adduction -indicates: ac joint pathology

What causes rotator cuff injuries

repated overhaed activity in sports or work

What is impigment syndrome?

compression of the rotator cuff tendons and subacromial bursa between greater tubercle of humeral head and lateral edge of accromion process

List 2 most common causes of shoulder pain

rotator cuff injuries and myofacscial injury

what does vindicate stand for?

vascular, infectious, neoplastic, degenerative, Iatrogenic, congenital, autoimmune, traumatic, and endocrine/metabolic

What does the apprehension test test for and what is a positive test?

-gleno humeral instability, patient apprehenive of repeated dislocation

What does the empty can test test for and what is a positive test?

rotator cuff pathology (supraspinatus specifically), pain or weakness is a positive test

What does the drop-arm test test for and what is a positive test?

Full thickness tear of the supraspinatus, arm will drop or gentle tap on the wrist will cause the arm to drop

What does the painful arc test test for and what is a positive test?

indicates subacromial impingement and/or rotator cuff injury, pain is elicited within 60-120 degrees of shoulder abduction

What does neer impingement test for and what is a positive test?

subacromial bursa or rotator cuff impingement, pain during passive flexion

What does the hawkin's test test for and what is a positive test?

rotator cuff or subacromial bursa impingement, pain with internal rotation

What does the cross arm test test for and what is a positive test?

AC joint pathology, pain in AC joint with end range adduction