Shoulder and upper arm diagnoses: Difference between revisions
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==Background== | |||
[[File:Gray326.png|thumb|Shoulder anatomy]] | [[File:Gray326.png|thumb|Shoulder anatomy]] | ||
==Differential Diagnosis== | |||
{{Shoulder DDX}} | |||
==Evaluation== | ==Evaluation== | ||
===Rotator Cuff Tests=== | ===Rotator Cuff Tests=== | ||
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**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 | ||
==See Also== | ==See Also== | ||
Revision as of 17:11, 29 October 2019
Background
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
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
- ↑ 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.