Shoulder and upper arm diagnoses: Difference between revisions

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==Diagnosis==
==Background==
[[File:Gray326.png|thumb|Shoulder anatomy]]
[[File:Shoulder_joint_back-en.png|thumb|Shoulder anatomy, anterior.]]
[[File:Shoulder joint back 05r4v.png|thumb|Shoulder anatomy, posterior.]]
 
==Differential Diagnosis==
{{Shoulder DDX}}
 
==Evaluation==
===Rotator Cuff Tests===
===Rotator Cuff Tests===
*Supraspinatus Test
*Supraspinatus Test (+ LR 3.2)
**Abduct arm to 90', forward flex it 30' w/ thumb down ("empy beer can position")
**Abduct arm to 90', forward flex it 30' with thumb down ("empty beer can position")
**Test for pain/weakness against resistance to continued abduction
**Test for pain/weakness against resistance to continued abduction
*Infraspinatus and Teres Minor Test
*Infraspinatus and Teres Minor Test
**Stabilize the elbow against the pt's waist and bend the elbow to 90'
**Stabilize the elbow against the patient's waist and bend the elbow to 90'
**Test for pain/weakness against resistance to external rotation
**Test for pain/weakness against resistance to external rotation
*Subscapularis Test
*External rotation lag sign - more specific to teres minor, given overlap between infraspinatus and teres minor<ref>Collin P et al. What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears? Clin Orthop Relat Res. 2015 Sep;473(9):2959-66.</ref>
**Support the arm to 20-30 degrees in scapular plane, externally rotated, elbow flexed to 90 degrees
**Positive test is pain or difficulty in keeping the arm from internally rotating when clinician lets go
*Subscapularis (+ LR 1.9)
**Place hand behind lower back
**Place hand behind lower back
**Test for pain/weakness as pt attempts to push examiner's hand away by moving dorsum of hand away from back
**Test for pain/weakness as patient attempts to push examiner's hand away by moving dorsum of hand away from back
*Drop arm test
*Drop arm test
**Pt is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction w/o dropping it
**Patient is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction with out dropping it


===Impingement Tests===
===Impingement Tests===
*Maneuver of Neer
*Maneuver of Neer
**Prevent scapular rotation w/ one hand while rasing pt's straightened arm in full forward flexion to overhead
**Prevent scapular rotation with one hand while raising patient's straightened arm in full forward flexion to overhead
**Positive sign is pain in the arc bewtween 70-120'
**Positive sign is pain in the arc between 70-120'
*Hawkins Impingement Test
*Hawkins Impingement Test
**Position the shoulder at 90' of abduction and elbow at 90' of flexion
**Position the shoulder at 90' of abduction and elbow at 90' of flexion
**Then rotate shoulder internally bringing the arm across the front of the pt
**Then rotate shoulder internally bringing the arm across the front of the pt
**Positive sign is pain during this maneuver
**Positive sign is pain during this maneuver
==Differential Diagnosis==
{{Shoulder DDX}}


==See Also==
==See Also==
*[[Diagnoses by Body Part (Main)]]
*[[Diagnoses by Body Part (Main)]]
*[[Shoulder X-ray]]
==References==


[[Category:Ortho]]
[[Category:Orthopedics]]
[[Category:Trauma]]
[[Category:Trauma]]
[[Category:Misc/General]]
[[Category:Misc/General]]
[[Category:Symptoms]]

Revision as of 20:53, 21 May 2020

Background

Shoulder anatomy
Shoulder anatomy, anterior.
Shoulder anatomy, posterior.

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

Rotator Cuff Tests

  • Supraspinatus Test (+ LR 3.2)
    • Abduct arm to 90', forward flex it 30' with thumb down ("empty beer can position")
    • Test for pain/weakness against resistance to continued abduction
  • Infraspinatus and Teres Minor Test
    • Stabilize the elbow against the patient's waist and bend the elbow to 90'
    • Test for pain/weakness against resistance to external rotation
  • External rotation lag sign - more specific to teres minor, given overlap between infraspinatus and teres minor[1]
    • Support the arm to 20-30 degrees in scapular plane, externally rotated, elbow flexed to 90 degrees
    • Positive test is pain or difficulty in keeping the arm from internally rotating when clinician lets go
  • Subscapularis (+ LR 1.9)
    • Place hand behind lower back
    • Test for pain/weakness as patient attempts to push examiner's hand away by moving dorsum of hand away from back
  • Drop arm test
    • Patient is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction with out dropping it

Impingement Tests

  • Maneuver of Neer
    • Prevent scapular rotation with one hand while raising patient's straightened arm in full forward flexion to overhead
    • Positive sign is pain in the arc between 70-120'
  • Hawkins Impingement Test
    • Position the shoulder at 90' of abduction and elbow at 90' of flexion
    • Then rotate shoulder internally bringing the arm across the front of the pt
    • Positive sign is pain during this maneuver

See Also

References

  1. Collin P et al. What is the Best Clinical Test for Assessment of the Teres Minor in Massive Rotator Cuff Tears? Clin Orthop Relat Res. 2015 Sep;473(9):2959-66.