Shoulder Differential Diagnoses Flashcards
(55 cards)
What are the key features of shoulder arthritis?
Pain, progressive functional impairment, instability. Passive horizontal adduction is the most painful motion.
What are common interventions for shoulder arthritis?
Rest, activity modification, NSAIDs, physical therapy, and joint mobilizations.
What treatments are used for rheumatoid arthritis?
Electrotherapy, cryotherapy, thermal modalities, ROM and strength exercises, corticosteroid injections, and surgery in severe cases.
What are the risk factors for frozen shoulder?
Female gender, over 40 years old, diabetes, trauma, prolonged immobilization, thyroid disease, stroke, myocardial infarction.
How does frozen shoulder progress?
Stages include ‘freezing’ (painful), ‘frozen’ (stiff), and ‘thawing’ (recovery).
What happens in Stage I (Freezing) of adhesive capsulitis?
Lasts less than 3 months, with pain at rest and sharp pain at extremes of ROM. Progressive loss of motion, mostly from synovitis.
What happens in Stage II (Freezing) of adhesive capsulitis?
Lasts 3-9 months. Pain in the anterior and posterior capsules, with significant loss of ROM in all planes.
if injection causes a decrease in pain and normalization of motion, Stage I is confirmed. If not, then Stage II is confirmed
What happens in Stage III (Frozen) of adhesive capsulitis?
Lasts 9-14 months. Pain decreases, but stiffness increases. Poor scapulohumeral rhythm and compensatory movements occur via trap and decreased inf. glide of GH
What happens in Stage IV (Thawing) of adhesive capsulitis?
Slow, steady recovery. Patients feel less restricted with minor improvements in ROM. Pain from long-standing inflammation resolves.
What is the difference between Stages III and I&II?
Pain goes away in Stage III and leaves just loss of motion
What is the difference between primary and secondary adhesive capsulitis?
Primary has no clear cause, is idiopathic, progressive, and has painful loss of active/passive shoulder motion, particularly ER
secondary is due to another condition, like trauma or diabetes and has two types (pain more vs. as noticeable as motion loss)
What are the interventions for frozen shoulder?
restoration of ROM
What is the timeline for corticosteroid injections for frozen shoulder?
<1mos onset, recovered in an average 1.5mos
<3mos onset, reported a significant improvement in symptoms
2-5mos onset, recovered in 8 months
>5mos or more onset, delayed recovery
What is glenohumeral instability?
It’s when the shoulder joint moves abnormally, often with a feeling of the shoulder ‘slipping’ or ‘popping out’ during OH activities.
What types of instability can occur?
Unidirectional, bidirectional, and multidirectional.
What does posterior instability result from?
avulsion of posterior glenoid labrum from glenoid
**rare, associated with seziure, electric-shock, diving into shallow pool, MVA
Exam findings from posterior shoulder instability?
Severe pain.
Limited external rotation (ER), often less than 0°.
Limited shoulder flexion (less than 90°).
Posterior prominence and rounding of the shoulder.
Flattening of the anterior aspect of the shoulder.
What is the most common shoulder instability?
anterior
What causes anterior shoulder instability?
usually caused by repetitive overhead activities. Traumatic injuries like a Bankart lesion (tearing of the anterior labrum) or Hill-Sachs lesion (compression fracture of the humeral head) are common causes
What are the symptoms of anterior instability?
Pain and a sensation that the shoulder is “out”.
Spasm often occurs to stabilize the joint.
Loss of internal rotation (IR) in young patients.
Subtle instability and posterior capsular contracture.
What causes inferior shoulder instability?
uncommon
typically caused by carrying heavy objects at the side
What is a SLAP lesion?
A tear in the superior labrum of the shoulder, often from trauma or repetitive overhead movements and both anterior and posterior.
Which aspect of the labrium is more prone to injury?
Superior aspect of the labrum is more mobile and prone to injury due to its close attachment to the LHB tendon
What causes a SLAP lesion?
sudden deceleration or traction forces (catching a falling heavy object, chronic anterior/posterior instability), fall, or MVA (using hands on wheel to stabilize during rear end)
