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Questions and Answers
“Pt is a 30 y/o male who presents with shoulder pain for 2 weeks." What crucial information must be included in the above statement?
“Pt is a 30 y/o male who presents with shoulder pain for 2 weeks." What crucial information must be included in the above statement?
What is NOT a major key question to ask a MSK patient?
What is NOT a major key question to ask a MSK patient?
If ACTIVE ROM is present, you can skip passive ROM.
If ACTIVE ROM is present, you can skip passive ROM.
True
Acute pain is less than 2 weeks. Chronic pain is greater than two weeks.
Acute pain is less than 2 weeks. Chronic pain is greater than two weeks.
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What movement is being shown in the picture for ROM of the shoulder?
What movement is being shown in the picture for ROM of the shoulder?
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What is being shown is this picture?
What is being shown is this picture?
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A baseball player presents with c/o considerable pain in his left shoulder with any movement, and is supports arm in neutral position. You order AP and Y x-ray and find an anterior movement of the shoulder. What are you mostly concerned for?
A baseball player presents with c/o considerable pain in his left shoulder with any movement, and is supports arm in neutral position. You order AP and Y x-ray and find an anterior movement of the shoulder. What are you mostly concerned for?
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A baseball player with a shoulder dislocation had an x-ray with bony defect on humeral head. What is this complication called?
A baseball player with a shoulder dislocation had an x-ray with bony defect on humeral head. What is this complication called?
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What is the main treatment for a patient with a shoulder dislocation?
What is the main treatment for a patient with a shoulder dislocation?
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Recurrence of shoulder dislocation is very common, especially if the injury was traumatic or if the patient was younger (under 20 years).
Recurrence of shoulder dislocation is very common, especially if the injury was traumatic or if the patient was younger (under 20 years).
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A patient was running when he fell directly on his left shoulder. You conduct special test and this patient had a positive "scarf or cross-over test" and was in lots of pain reach to their opposite shoulder. He indicates AC joint pain. You order bilaterally imaging (bilateral AP xray) for comparison and find a "step-off” deformity" on the left. What is likely?
A patient was running when he fell directly on his left shoulder. You conduct special test and this patient had a positive "scarf or cross-over test" and was in lots of pain reach to their opposite shoulder. He indicates AC joint pain. You order bilaterally imaging (bilateral AP xray) for comparison and find a "step-off” deformity" on the left. What is likely?
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An 60 year old man in good fitness presents with night time shoulder pain, weakness and pain with overhead reaching. The patient declines any specific trauma, but is an athlete. The patient struggles to complete active range of motion in the forward flexion & abduction and tries to "hike up" his arm to complete the motion. He does have full passive ROM. What is likely?
An 60 year old man in good fitness presents with night time shoulder pain, weakness and pain with overhead reaching. The patient declines any specific trauma, but is an athlete. The patient struggles to complete active range of motion in the forward flexion & abduction and tries to "hike up" his arm to complete the motion. He does have full passive ROM. What is likely?
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You have a patient with a rotator cuff tear. The x-ray (initial test) shows high riding humeral head on the AP view. What is diagnostic for RTC?
You have a patient with a rotator cuff tear. The x-ray (initial test) shows high riding humeral head on the AP view. What is diagnostic for RTC?
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When should a patient with a rotator cuff tear see ortho for surgery options?
When should a patient with a rotator cuff tear see ortho for surgery options?
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A patient presents in a great deal of pain and swelling in the right upper arm. The patient was playing on the swings when she fell on her outstretched arm. The patient does not have signs of puncture. You ask the patient to hold their wrist out, but the patient cannot extend their wrist and reports numbness. AP/Lateral x-rays are ordered for diagnosis. What is likely?
A patient presents in a great deal of pain and swelling in the right upper arm. The patient was playing on the swings when she fell on her outstretched arm. The patient does not have signs of puncture. You ask the patient to hold their wrist out, but the patient cannot extend their wrist and reports numbness. AP/Lateral x-rays are ordered for diagnosis. What is likely?
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An elderly woman presents with severe pain, swelling, bruising of the R arm. She has swelling, discoloration, and decreased ROM in that arm. You also find that the forearm/hand are both pale. X-ray are ordered. What is likely?
An elderly woman presents with severe pain, swelling, bruising of the R arm. She has swelling, discoloration, and decreased ROM in that arm. You also find that the forearm/hand are both pale. X-ray are ordered. What is likely?
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Clavicle Fractures are the MOST common bony injury.
Clavicle Fractures are the MOST common bony injury.
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A young male patient presents with pain, limited ROM of left shoulder, difficulty lying on the left side. PE shows bump and TTP on the bump. AP view is shown in image. What is likely?
A young male patient presents with pain, limited ROM of left shoulder, difficulty lying on the left side. PE shows bump and TTP on the bump. AP view is shown in image. What is likely?
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An elderly man presents with sudden onset of pain and notes an audible “pop" in their left arm. On PE, you notice ecchymosis, bulge near bicep on left arm, and palpable defect. Imaging ruled out fracture. What is likely?
An elderly man presents with sudden onset of pain and notes an audible “pop" in their left arm. On PE, you notice ecchymosis, bulge near bicep on left arm, and palpable defect. Imaging ruled out fracture. What is likely?
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A patient presents with painful clicks and pops especially in the overhead motion. The patient is a swimmer. You preform the O'brein test by having the patient hold a thumb down and applying resistance, they have pain. You then have the patient put thumb up and apply resistance, and pain improves. You know this is a positive test. Xray was normal, but MR arthrogram shows leaking dye and diagnosis this as:
A patient presents with painful clicks and pops especially in the overhead motion. The patient is a swimmer. You preform the O'brein test by having the patient hold a thumb down and applying resistance, they have pain. You then have the patient put thumb up and apply resistance, and pain improves. You know this is a positive test. Xray was normal, but MR arthrogram shows leaking dye and diagnosis this as:
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A football player reports that his head was pushed sideways in the recent game. He now c/o stinging/burning from shoulder to hand on the left side. The pain is temporary and resolve quickly, but still bothersome. You find that this patient has a positive Spurling’s maneuver (extend/lat flex/rotate neck to affected side + axial load = pain). What is likely?
A football player reports that his head was pushed sideways in the recent game. He now c/o stinging/burning from shoulder to hand on the left side. The pain is temporary and resolve quickly, but still bothersome. You find that this patient has a positive Spurling’s maneuver (extend/lat flex/rotate neck to affected side + axial load = pain). What is likely?
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RC tendonitis and subacromial bursitis leads to Impingement Syndrome.
RC tendonitis and subacromial bursitis leads to Impingement Syndrome.
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A patient presents with gradual onset of pain since starting to paint his house. He reports anterior/lateral shoulder pain, but it is especially worse with overhead activities. You tell the patient that this is an injury of overuse called:
A patient presents with gradual onset of pain since starting to paint his house. He reports anterior/lateral shoulder pain, but it is especially worse with overhead activities. You tell the patient that this is an injury of overuse called:
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What tests look for Impingement Injuries?
What tests look for Impingement Injuries?
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A patient presents with TTP over proximal biceps tendon in bicipital groove, but no deformity or bulging of the muscle. The patient has a positive Yergason's test (resisted supination with elbow at 90 deg flexion at side) and Speed’s test (FF to 90 deg, resisted palm up). What is likely?
A patient presents with TTP over proximal biceps tendon in bicipital groove, but no deformity or bulging of the muscle. The patient has a positive Yergason's test (resisted supination with elbow at 90 deg flexion at side) and Speed’s test (FF to 90 deg, resisted palm up). What is likely?
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A 40 year old T1DM presents with pain with motion of shoulder. You notice that the patient cannot complete active ROM, but when you try passive ROM, you cannot get the arm to move either. X-ray are normal. What is likely?
A 40 year old T1DM presents with pain with motion of shoulder. You notice that the patient cannot complete active ROM, but when you try passive ROM, you cannot get the arm to move either. X-ray are normal. What is likely?
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Your patient presents with left posterior shoulder pain that is worse with activity and at night. On exam, you find shoulder muscle atrophy, TTP over joint lines, decreased ROM, and crepitus. X-ray shows the destruction of joint cartilage resulting in joint space narrowing. What is likely?
Your patient presents with left posterior shoulder pain that is worse with activity and at night. On exam, you find shoulder muscle atrophy, TTP over joint lines, decreased ROM, and crepitus. X-ray shows the destruction of joint cartilage resulting in joint space narrowing. What is likely?
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You should always include the patient's dominant hand in notes.
You should always include the patient's dominant hand in notes.
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Repetitive overhead micro trauma to capsule of the shoulder can lead to what condition when the shoulder "slips out?"
Repetitive overhead micro trauma to capsule of the shoulder can lead to what condition when the shoulder "slips out?"
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X-ray findings on the shoulder.
X-ray findings on the shoulder.
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A 30 year old female presents with c/o left arm pain from her neck to her forearm. It worsens when she lifts her arm. Patient has pain with Adson’s test and Elevated arm stress test (EAST). What condition is likely?
A 30 year old female presents with c/o left arm pain from her neck to her forearm. It worsens when she lifts her arm. Patient has pain with Adson’s test and Elevated arm stress test (EAST). What condition is likely?
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Study Notes
Patient Presentation and History
- A 30-year-old male presents with shoulder pain for 2 weeks, which is considered chronic pain
- Acute pain is less than 2 weeks, while chronic pain is greater than 2 weeks
Range of Motion (ROM) and Movement
- ACTIVE ROM is present, which allows skipping passive ROM
- The picture shows abduction movement of the shoulder
Shoulder Dislocation and Complications
- A baseball player presents with considerable pain in the left shoulder, with an anterior movement of the shoulder on AP and Y x-ray
- The patient is mostly concerned for shoulder dislocation
- A bony defect on the humeral head on x-ray is a complication called Hill-Sachs lesion
- Main treatment for a patient with a shoulder dislocation is reduction
- Recurrence of shoulder dislocation is very common, especially if the injury was traumatic or if the patient was younger (under 20 years)
AC Joint Pain and Injuries
- A patient with a positive "scarf or cross-over test" and "step-off" deformity on x-ray is likely to have AC joint pain
- Bilateral AP x-ray is used for comparison to diagnose AC joint pain
Rotator Cuff Tear and Injuries
- A patient with night time shoulder pain, weakness, and pain with overhead reaching may have a rotator cuff tear
- High riding humeral head on the AP view is diagnostic for rotator cuff tear
- A patient with a rotator cuff tear should see an orthopedic surgeon for surgery options
Other Shoulder Injuries
- A patient with a fall on an outstretched arm and pain, swelling, and numbness in the right upper arm is likely to have a radial nerve injury
- A patient with severe pain, swelling, bruising, and decreased ROM in the arm is likely to have a brachial artery injury
- A patient with a bump and TTP on the bump is likely to have a clavicle fracture
- A patient with sudden onset of pain and an audible "pop" in the arm, with ecchymosis, bulge, and palpable defect, is likely to have a biceps tendon rupture
Impingement Syndrome and Tests
- A patient with painful clicks and pops, especially in the overhead motion, may have Impingement Syndrome
- The O'Brien test is used to diagnose impingement injuries
- RC tendonitis and subacromial bursitis lead to Impingement Syndrome
Other Conditions
- A patient with gradual onset of pain, especially with overhead activities, may have Impingement Syndrome
- A patient with pain and weakness in the shoulder, with a positive Yergason's test and Speed's test, is likely to have biceps tendonitis
- A patient with pain and limited ROM, with a positive Spurling's maneuver, is likely to have a cervical spine injury
- A patient with TTP over proximal biceps tendon, but no deformity or bulging, is likely to have biceps tendonitis
- A patient with pain and limited ROM, with x-ray showing destruction of joint cartilage, is likely to have osteoarthritis
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Description
Learn about the essential details that should be included in a patient history statement for proper diagnosis and treatment.
