MSK module 3 week 3 shoulder diff diagnosis stuff Flashcards
Shoulder Pathologies
Prevalence
16%
“Proportion of the population that have shoulder pain
in a given time”
Incidence
**37.8/1000 person-years over a period of 5 years
(female > male)
“The number of new cases of shoulder pain in a
population during specified time period”
Inflammatory Injuries
Bursitis
Tendonitis, rotator cuff/biceps
Intra-articular injuries
Arthritis, labrum
Frozen shoulder
Traumatic Injuries
Fracture
Tearing – rotator cuff, labrum
Instability Injuries
Dislocation, hypermobility, labrum
Examination - Order Outlined in Dutton - non touching them stuff
- Patient History
- Observation
- MOI
- Location
- Referral…
- Behavior of symptoms
- Stage of healing
- Tissue specific reporting
- Scanning
- Systems review
Examination - Order Outlined in Dutton - touching them stuff now
- AROM
- Add OP
- Resistive Tests
- DTRs
- Sensation Testing
- Special Testing
History taking/med chart review/subj
*30 Second Snapshot
Age
Ethnicity
Gender
Morphology
Past Medical History (PMH)
Common injuries and MOI
Remember “the shoulder”Subacromial space, Rotator cuff overuse, Scapulae stability/mobility, Resting posture
ADLs/Work related tasks, Spine impairments
at end of subjective think…..
SINSS
SINatureSS
nociceptive (phsiologic) input, peripheral neuropathic, central nociplastic, maladaptive cognitions, sensorimotor dysintegration, emotional/affective dysregulation, socio/environmental factors
Investigate the Nature
Ligamentous:
Passive restraints/components of the shoulder
Accessory motion testing (mobility)
Neuromuscular:
Production of movement or control of shoulder
Movement, functional, coordination testing
Joint related:
Intra-articular - AC, SC, GH, ST
Accessory motion testing (mobility)
Muscle:
Contractile, responds to resistance and length
Strength, power, endurance
Muscle performance testing
Neurogenic
TOS
Cervical
Neuro screen/testing
Objective Examination Flow
- Observation
- Resting posture global
- Resting posture local
- Scapulae, GH joints, thoracic
and cervical spine
palpation
neuroscreen
range of motion
-over pressure for end feel
resistive tests
RIMS
MMT
flexibility testing
neuro review
special testing
joint mobility testing
special tests for
subacromial impingement
infraspinatus test RC disease
hawkins kennedy test
neer test
neer impingement sign for subacromial bursitis
hawkins impingement sign for subacromial bursitis
horizontal adduction test
Biceps Tendonitis
- Patient Details
- Age:
- 20-45 y/o
- Gender
- Equal
- Morphology
- All variations
- Past Medical History (PMH)
- Similar to RTC
Biceps Tendonitis pathophysiology
Pathophysiology
Proximal (long head) of biceps tendon presents as anterior shoulder pain with insidious onset
Overhead activities may contribute to cause and provocation
New overhead activity or increase
in activity suspected inflammation
at the biceps tendon and
surrounding sheath
Commonly a secondary cause
versus the primary issue
Biceps Tendonitis subjective reports
- Subjective Reports
- Anterior shoulder pain at biceps tendon
- Worse with OH activities
- Recent increase in activity suspected
- Pain going down the anterior arm
(following biceps brachii) - Clicking/popping at biceps tendon if
unstable
Biceps Tendonitis objective findings
- Objective Findings
- AROM painful, moreso overhead
- Painful elbow flexion
- Painful palpation
- Painful biceps special testing
- Ruled out RTC involvement
- Cervical nerve roots ruled out
- Secondary impairments at scapulae and
thoracic spine - Consider labral testing if indicated (SLAP)
Bursitis
patient details
- Patient Details
- Age:
- Varies
- Gender
- Equal
- Morphology
- Similar to RTC
- Past Medical History (PMH)
- Similar to RTC
bursitis pathophysiology
Aggravation and inflammation of the
subacromial bursa due to mechanical
compression
Common overuse pain generator
Common to be a secondary painful component
with RTC, labrum or joint related pathology
Subacromial Bursitis subjective
- Subjective Reports
- Similar to RTC
- Pinpoint pain, to the subacromial
space - Pain with movements that
compress the space (OH,
adduction, rotation extremes)
subacromial bursitis objective
- Objective Findings
- Impingement testing positive
- Rule in/out contribution from RTC
and intra-articular structures
Adhesive Capsulitis patient details
Patient Details
* Age
* Over 40 y/o
* Ethnicity
* White may increased risk
* Gender
* Female > Male
* Morphology
* Overweight, obese
* Past Medical History (PMH)
* Family history
* Thyroid disease, CV disease
* DBM: Incidence in patients
with diabetes is as high as
20%
Adhesive Capsulitis pathophysiology
- Pathophysiology
- Primary can occur spontaneously whereas
secondary can occur following trauma or
surgery - 4 Stages of progression
- Inflammation at the synovial capsule
(synovitis) leading to fibrosis and dense
collagenous tissue within the capsule - Often in nondominant hand
- 3-5% incidence in general population
- Self limiting at 1-3 years, long lasting
symptoms can persist
Adhesive Capsulitis subjective
Intense pain and loss of motion in early phases,
less pain more loss of motion later on
Seemingly gradual/insidious onset if primary
Pain with all motions
Minimal relief reported
Adhesive Capsulitis objective
- Objective Findings
- AROM limited and painful all
direction - PROM limited with capsular end
feel - Limited joint mobility
- ER very limited
- Pain with resisted muscle testing
- Diffuse pain broadly around
shoulder
AC joint sprain patient details
- Patient Details
- Age:
- varies
- Gender
- varies
- Morphology
- varies
- Past Medical History (PMH)
- MOI/Trauma
- Activities with high risk of fx
AC joint sprain patho
Pathophysiology
Direct blow to the AC joint, landing on
the side
FOOSH with compression injury through
the arm into the AC joint
Disruption of ligamentous and capsular
support around joint
Varying levels and grades
Non-operative and operative
rehabilitation options
AC joint sprain subjective
Subjective Reports
Mechanism of injury
Pointing directly to the joint
Visible step deformity if severe
