Shoulder and upper arm diagnoses: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
* | ===Rotator Cuff Tests=== | ||
*Supraspinatus Test | |||
**Abduct arm to 90', forward flex it 30' w/ thumb down ("empy beer can position") | |||
**Test for pain/weakness against resistance to continued abduction | |||
*Infraspinatus and Teres Minor Test | |||
**Stabilize the elbow against the pt's waist and bend the elbow to 90' | |||
**Test for pain/weakness against resistance to external rotation | |||
*Subscapularis Test | |||
**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 | |||
*Drop arm test | |||
**Pt is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction w/o dropping it | |||
===Impingement Tests=== | |||
*Maneuver of Neer | |||
**Prevent scapular rotation w/ one hand while rasing pt's straightened arm in full forward flexion to overhead | |||
**Positive sign is pain in the arc bewtween 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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 05:27, 18 February 2015
Diagnosis
Rotator Cuff Tests
- Supraspinatus Test
- Abduct arm to 90', forward flex it 30' w/ thumb down ("empy beer can position")
- Test for pain/weakness against resistance to continued abduction
- Infraspinatus and Teres Minor Test
- Stabilize the elbow against the pt's waist and bend the elbow to 90'
- Test for pain/weakness against resistance to external rotation
- Subscapularis Test
- 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
- Drop arm test
- Pt is unable to hold or smoothly lower an extended arm at 90' of shoulder abduction w/o dropping it
Impingement Tests
- Maneuver of Neer
- Prevent scapular rotation w/ one hand while rasing pt's straightened arm in full forward flexion to overhead
- Positive sign is pain in the arc bewtween 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
Differential Diagnosis
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism