Shoulder Pain Flashcards
(26 cards)
Common cause of shoulder rotator cuff tear?
Genohumeral dislocation
- frequency 7-32% after dislocation
Patients >40 with a first time dislocation and weakness >3 wks following the injury think?
Rotator cuff tear
MC complication of calcific tensonitis?
Adhesive capsulitis
Conditions that contribute to primary or idiopathic adhesive capsulitis?
Diabetes
Thyroid disease
Postmenopausal
Pulmonary neoplasm
Autoimmune d/o
Causes of secondary adhesive capsulitis
Prolonged immobilization after:
- trauma
- surgery
- stroke
Or primary inflammatory condition of shoulder like
- impingement syndrome
- bicipital tendonitis
What causes partial or complete biceps tendon rupture?
- Micro-tears
- age-related degeneration
MC bicepts tendon rupturelocation?
Proximal
History of injury with young patients presenting with biceps tendon tear
Audible snap/pop
Pain
With deformity
Tests for biceps tendon rupture
Speeds test: pain in bicipital groove
Uppercut test: painful pop on anterior portion of involved shoulder
Classic findings for biceps tendon rupture?
“Popeye” deformity
- distal contracture of the muscle belly
Weakness with supination
Normal elbow flexion
Why is supination weak but elbow flexion is strong in biceps tendon rupture?
Intact elbow flexors:
- short head of biceps
- brachialis muscles
Gold standard for diagnosis of biceps tendon rupture?
Arthroscopy
Imaging for biceps tendon rupture
MRI arthrogram
Radiographs and MRI arent great
US with a good operator is as good as MRI (50%)
Therapy for biceps tendon rupture
Surgery
- need ortho evaluation in 24-48hrs
Chronic rotator cuff tear history
HX: gradual, progressive pain, worse at night with no specific injury
Pain localized in the lateral aspect of the upper arm
Worst with elevation, external rotation and lifting
acute rotator cuff tear history
Pain, disability, and asymmetry due to swelling
Active motion limited with inability to abduct or externally rotate the arm against resistance
Acute rotator cuff tear exam
TTP on lateral aspect of arm or in subacromial region
Weakness and pain on abduction, elevation, and external rotation
Drop arm test positive
Crepitus and pain with ROM
DDX for referred shoulder pain
Cervical spine
Brachial plexus
Axillary artery thrombisis
Subscapular nerve injury
Thoracic outlet syndrome
Pancoat’stumor
Misc thoracoabcominal d/o
MC source of referred pain in shoulder?
Neck
C5-C6 injury may present as?
Rotator cuff disease
Brachial plexus injury may present as?
Referred pain to shoulder
Weakness
rapid atrophy of muscle
- within one weak
Most serious vascular injury that can cause shoulder pain?
Acute thrombosis of the axillary artery
What causes thoracic outlet syndrome?
Compression of the brachial plexus and blood vessels proximal to the shoulder
What does a pancoat’s tumor cause?
Compression of the brachial plexus against chest wall causing shoulder pain
May be
- local
- radicular
- sense of fullness in supraclavicular fossa
