MSK - Shoulder pain

Question 1

Causes of shoulder pain

Answer 1

• overuse (overhead arm movement)
• degenerative processes
• trauma
• inflammation
• post-operative changes

Question 2

POLICE principle

Answer 2

P - protection
OL - optimal loading
I - ice
C - compression
E - elevation

Question 3

A syndrome of pain during shoulder abduction, forward flexion and/or extreme adduction associated with narrowing of the subacromial space

Answer 3

Subacromial impingement syndrome

Question 4

Impingement syndrome happens because of

Answer 4

impingement of the greater tuberosity on the acromion

Question 5

What are some of the etiologies of subacromial impingement syndrome?

Answer 5

• rotator cuff disease
• subacromial bursitis
• biceps tendinopathy

Question 6

What are the shoulder impingement tests?

Answer 6

1. Hawkins Kennedy test
2. Neer test
3. Painful arc

Question 7

A physical exam maneuver used to assess the presence and degree of rotator cuff impingement by elevating the patient’s internally rotated and outstretched arm with simultaneous stabilization of the scapula.

Answer 7

Neer test (Full can test)

Question 8

What does a positive Neer test mean?

Answer 8

Pain indicates a narrowed subacromial space and impingement, particularly of the supraspinatus muscle and tendon

Question 9

Test for subacromial impingement syndrome where the patient’s arm is 90º anteversion and flexes the elbow to 90º.

Answer 9

Hawkins Kennedy test

Question 10

What does a positive Hawkins Kennedy test mean?

Answer 10

Pain during internal rotation is a non-specific indication of impingement syndrome

Question 11

A physical exam maneuver where the patient abducts and raises their extended arm.

Answer 11

Painful arc test

Question 12

What does a positive painful arc test mean?

Answer 12

• pain from 60°-120° = subacromial impingement
• pain from 120°-170° means pathology of the AC joint
• pain from 0°-180° means glenohumoral pathology (osteoarthritis or frozen shoulder)

Question 13

What are the muscles of the rotator cuff?

Answer 13

• Subscapularis
• Teres minor
• Supraspinatus
• Infraspinatus

Question 14

Inflammatory or degenerative changes to one or more of the rotator cuff tendon

Answer 14

Rotator cuff tendinitis

Question 15

Initial treatment for rotator cuff tendinitis

Answer 15

• rest
• ice
• physical therapy
• NSAIDs

Question 16

Most common cause of shoulder pain

Answer 16

Supraspinatus (rotator cuff) tendinitis

Question 17

Rotator cuff tears are often preceded by ____ and most commonly involve the ____

Answer 17

rotator cuff tendonitis; supraspinatus tendon

Question 18

A large tear in the tendons of one or more muscles in the rotator cuff often due to progression of smaller tears and inflammation

Answer 18

Rotator cuff tear

Question 19

What positive test suggests supraspinatus (rotator cuff) tear?

Answer 19

Positive drop-arm test

Question 20

What test specifically exams the supraspinatus?

Answer 20

Empty can test (Jobe test)

Question 21

A physical examination maneuver used to assess the supraspinatus where the patient outstretches and internally rotates their arm so that the thumb faces downward, which minimizes the effect of the deltoid muscle on abduction.

Answer 21

Empty can test

Question 22

What does a positive Empty can test mean?

Answer 22

Injury to the supraspinatus tendon or muscle or injury to the suprascapular nerve

Question 23

A physical examination maneuver to assess infraspinatus muscle function where the patient stands with the elbow flexed at 90º and force is applied to the patient’s lateral underarm, which creates an internal rotation movement in the shoulder.

Answer 23

Infraspinatus test

Question 24

What test specifically exams the subscapularis test?

Answer 24

Lift-off test

Question 25

A physical examination maneuver used to assess the subscapularis muscle where the patient places their hand on the lower back with the palm facing outwards and lifts the arm posteriorly off the back against resistance.

Answer 25

Lift-off test

Question 26

What does a positive Lift-off test mean?

Answer 26

Considered positive if the patient cannot lift the arm posteriorly, which indicates injury to the subscapularis muscle or tendon.

Question 27

Xray findings that support rotator cuff tear

Answer 27

Superior displacement of the humeral head (high riding humeral head)

Question 28

Indications for surgical repair of rotator cuff tear

Answer 28

- younger than 65 - acute, traumatic full-thickness tears - chronic full thickness tears - inadequate improvements after 3-6 months of conservative treatment

Question 29

Complication of rotator cuff tear

Answer 29

Adhesive capsulitis (frozen shoulder)

Question 30

Inflammation and fibrosis of the joint capsule leading to contracture of the shoulder joint

Answer 30

Adhesive capsulitis (frozen shoulder)

Question 31

What are the stages of adhesive capsulitis?

Answer 31

- freezing - painful stage, minimal synovitis with pain causing limited ROM - frozen - transitional stage where pain decreased but synovitis continues with axillary adhesions and contraction of the capsule - thawing - inflammation decreases and movement slowly improves

Question 32

What is a SLAP lesion?

Answer 32

a tear in the superior glenoid labrum and long head of the biceps tendon

Question 33

Shoulder pain with limited range of motion, catching or locking sensation with motion, occasional instability of the shoulder joint as a result of acute trauma

Answer 33

Glenoid labrum tear

Question 35

Partial dislocation of the shoulder joint that often arises from acute or chronic disruption of the muscles, ligaments, soft tissues, and bones of the joint; presents with shoulder pain, deformity and limited range of motion, usually following a traumatic injury sustained by the shoulder

Answer 35

Glenohumeral subluxation