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| ==I. Normal Shoulder Exam==
| | #REDIRECT[[Shoulder and upper arm diagnoses]] |
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| A. Referred Pain
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| i. Cervical radiculopathy
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| -Suggested by pain radiating below shoulder or to upper back
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| -decreased range of motion in neck due to pain,
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| -positive Spurling's test (radicular pain with head compression)
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| -normal shoulder exam
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| ii. Lung (apical lung tumor, pleural disease)
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| iii. Heart (MI)
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| iv. Subdiaphragmatic (gallbladder disease)
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| v. Vascular (Thoracic Outlet Sy)
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|
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| ==II. Point Tenderness==
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| 1. Rotator Cuff
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| Injury: 90% chronic arms overhead
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| Diag:
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| -result of extreme overuse in young adults (e.g. pitchers) or minor
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| trauma in older adults
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| -sudden "pop" while lifting overhead
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| -lateral pain
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| -worse at night
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| -abduct arm pain after 20deg
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| -relief of pain w/ lido inject
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| (pain free weakness = full tear)
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| PE: -loss of active BUT NOT passive ROM (due to pain)
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| -positive impingement signs
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| -weakness with drop arm test
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| Rx: Acute --> sling, PT, ortho f/u
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| Chronic --> PT, ortho
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| Next: MRI, surgery for younger pts with big tear, rehab
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| PT: arm dangle at side, circle 5-10wt
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| 2. Adhesive Capulitis (Frozen Shoulder)
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| Diag:
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| -diffuse/dull ache
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| -result of prolonged immobilization of shoulder
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| -loss of active AND passive ROM
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| -pain at extremes of motion
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| Rx: PT, ortho f/u
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| -rehab for 18 mo, manipulation under anesthesia if no improvement
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| 3. Bicipital Tendinitis
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| -result of repetitive flexion-extension or pronation-supination of elbow
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| -PE: anterior shoulder pain with flexion at elbow (curling) or
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| resisted forearm supination, tenderness over bicipital groove
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| 4. Subacromial Bursitis and Supraspinatus Tendinitis
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| -result from repetitive overhead arm movement (e.g. serving in tennis
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| or throwing baseball), gradual onset
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| -PE: positive impingement signs, pain but no weakness with drop arm test
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| 5. Impingement Syndrome
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| -definition: narrowing of impingement interval (space between superior
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| aspect of humeral head and inferior aspect of acromion)
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| (supraspinatus tendon runs through this space, also subacromial and
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| subdeltoid bursae are there)
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| Diag:
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| -pain exacerbated by overhead arm movements
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| -nocturnal pain exacerbated by sleeping on affected shoulder
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| -weakness
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| -loss of motion
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| PE:
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| -positive impingement signs
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| -pain with elevation of arm with elbow flexed (like military salute)
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| against resistance
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| -positive drop arm test
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| -point tenderness at impingement interval
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| causes: abduction of arm (normal), structural variations of acromion
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| (types II and III), osteoarthritic spurs of acromioclavicular (AC)
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| joint, calcification and thickening of coracoacromial ligament, loss
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| of rotator cuff strength resulting in superior migration of humerus,
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| among others
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| Other
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| -osteoarthritis (usually acromioclavicular joint), rheumatoid
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| arthritis, septic arthritis, gout, lyme disease, SLE,
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| spondyloarthropathy
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| ==Source==
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| 8/07 DONALDSON (adapted from Miller, Mistry)
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| [[Category:Ortho]]
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