Shoulder Visceral and Vascular

Question 1

Left shoulder

Answer 1

Heart
Stomach
Pancreatitis
Spleen (via Kehr’s sign)

Question 2

Heart

Answer 2

• Angina (U/S)
• MI
• May also present with jaw, face, neck pain

Question 3

Pancreatitis

Answer 3

• Steatorrhea - fat in stool, pale in colour and may float
• Epigastric or Abdo pain

Question 4

Spleen

Answer 4

*Splenomegaly (Enlarged Spleen):
- Infections (like mononucleosis), liver diseases (cirrhosis), blood cancers (leukemia, lymphoma), and autoimmune diseases.
- Pain or fullness in the upper left abdomen, fatigue, anemia, and increased susceptibility to infections.

*Splenic Rupture:
- Blunt abdominal trauma, infections, or splenomegaly can increase the risk of rupture.
- Severe abdominal pain, tenderness in the upper left abdomen, dizziness, and signs of shock (low blood pressure, fainting).

Question 5

Stomach

Question 6

R shoulder

Answer 6

Liver
Gall bladder

Question 7

Liver

Answer 7

First signs: Jaundice sclera, itchy skin, bloating
*GI:
Sense of fullness of the abdomen
Anorexia, nausea and vomiting

*Visual:
Change in skin colour and nail beds (whitening)
Pallor (cirrhosis or carcinoma)
Jaundice
Bruising
Spider angioma
Palmar erythema
White nails of terry

*Hepatic
Dark urine and light coloured stools
Ascites
Edema
RUQ pain

*Neurologic
Confusion, sleep disturbance, muscle tremors, hyperactive reflex, asterixis, Bi carpal tunnel or tarsal tunnel.

Question 8

Gall Bladder

Answer 8

• steatorrhea
• Murphy’s sign
• Right upper abdominal pain
• Indigestion, nausea, feeling of fullness
• Excessive belching or flatulence
• Jaundice
• Persistent pruritus
• Sudden excruciating pain in mid epigastrium referral to back and right shoulder
• Anterior rib pain 10th rib possible 11&12
• Low grade fever and chills.
• Pain 1-3 hours after eating

RF:
- Age
- Elevated estrogen levels (pregnancy, oral contraceptives or HRT)
- Obesity
- High cholesterol, low fibre
- DM
- Liver disease
- Rapid weight loss
- Statins
- Family Hx

Question 9

Vascular causes

Answer 9

TAA
MI
Angina
TOS vascular
PAD
Calcific rotator cuff

Question 10

TOS vascular

Answer 10

• P+N in UEXT
• 6 Ps
• Swelling or heaviness
• Postural related TOS?
• 10% of cases are vascular
• Blood pressure in both arms
• Bikeles/adsons test

Causes:
- Cervical Ribs
- Abnormal First Rib
- Clavicle Fractures
- Fibrous Bands or Ligaments

Question 11

PAD

Answer 11

Upper limb claudication

Other DDX = Giant cell arteritis

6Ps

Question 12

Calcific rotator cuff

Answer 12

1:Pre-Calcific stage:

• Reduced blood supply causes degeneration within tendon

2:Calcific Stage:
- Formative Phase: Calcium crystals start to form in the tendon.
- Resting Phase: The calcium deposit may not cause symptoms and may remain stable for some time.
- Resorptive Phase: The body begins to break down and absorb the calcium, which often triggers intense inflammation and pain.
- Post-Calcific Stage: After the calcium is resorbed, the tendon heals, but some stiffness and pain may persist during recovery.