Shoulder pain (DDx) – HY
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Notes
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PEx
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X-ray
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Adhesive capsulitis
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· fibrosis leading to ⤵️ distensibility
· common in middle-aged or elderly
· common w/ rotator cuff tear + proximal humeral fx
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⤵️ Active & passive ROM
Stiffness + pain
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ⓝ
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Rotator cuff impengment
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Follow an inury (FOOSH)
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· ⓝ Passive ROM
· ⤵️ Abduction + External Rotation
· Subacromial pain
· ⊕ Impengment tests (Neer + Hawkins)
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ⓝ
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Rotator cuff tear
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FOOSH
Age > 40 ys
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· Weakness (rather than just pain)
· ⓝ passive ROM
· ⊖ Impengment tests (Neer + Hawkins)
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ⓝ
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Rotator cuff tendinitis
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· Overuse
· Supraspinatus
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=
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ⓝ
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Biceps tendinopathy
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· Anterior shoulder Pain
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⤵️ Flexion (biceps) especially w/ carrying stuff, overhead reaching
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ⓝ
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Glenohumeral OA
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· Caused by trauma
· Anterior / deep shoulder pain
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⤵️ ACTIVE + PASSIVE ABDUCTION + EXTERNAL ROTATION
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🆎 (OA findings)
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Calcific Tendinopathy
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Hydroxyapatite deposits on rotator cuff
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· ⓝ Passive ROM
· PAINFUL abduction
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calcifications
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Shoulder Dislocation
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Clx
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Dx
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Clx – X-ray
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Tx
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Rotator cuff tendinopathy & tear
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Rotator cuff impingement or tendinopathy
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· Pain with abduction, external rotation
· Subacromial tenderness
· ⓝ ROM with ⊕ impingement tests (Neer, Hawkins)
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Rotator cuff tear (انقطع)
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· FOOSH/Hx of TRAUMA
· Similar to rotator cuff tendinopathy
· Weakness with abduction & external rotation
· NORMAL PASSIVE ROM
· Age >40
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Lateral epicondylitis
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Clx
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• Subacute to chronic lateral elbow pain
• History of repetitive or forceful wrist extension
• Peak incidence age 45-54
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Dx
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• Tenderness at epicondyle & proximal extensor muscles
• Pain with resisted wrist extension or supination
• Pain with passive wrist flexion
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Tx
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• Modified activity & ergonomics
• Inelastic counterforce brace
• Nonsteroidal anti-inflammatory drugs (topical or oral)
• Stretching & progressive resistance exercise
• Physical therapy
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De quivern tenosynovitis
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features
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Inflammatio of 1st extensor compartement
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S/S
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+ fenkelstein (make fist –> pain)
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Dx
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Clx
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Tx
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· NSAIDS
· Forearm-based thumb spica splint
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Complex regional pain syndrome
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Trigger
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Trauma: fracture, sprain
Surgery
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S/S
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· Pain: severe, regional (not dermatomal), burning/stinging
· Edema, abnormal sweating (non-pitting)
· Vasomotor changes, altered skin temperature
· Trophic skin, hair & nail changes
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Dx
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· Primarily clinical
· X-ray: patchy demineralization ✳️
· Bone Scan: ⤴️ uptake in affected limb
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Tx
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· Physical & occupational therapy,
· Exercise
· 💊 NSAlDs / Antineuropathic medications (eg, pregabalin, TCAs)
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Supracondylar Fx
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Clx
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FOOSH – Pain, swelling, limited ROM
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Dx
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X-ray: occult fx (خفي): Posterior fat pad (usually absent), fx line, or displacement of humerus
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Tx
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Nondisplaced: long arm splint & sling
Displaced: surgical reduction & pinning
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Comp
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Neurovascular injury
· Brachial a: diminished distal pulse
· Median n: TRANSIENT motor/sensory loss
Compartment syndrome
· ⤴️ Swelling + Pain unresponsive to analgesics
· 4 Ps (Pulseless, Pale, Parasthesia, Paralysis)
· 1˚: Remove Bandages
· 2˚: Measure compartment pressure
· 3˚ Fasciotomy Emergently
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Carpal Tunnel Syndrom
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RF
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Clx
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Dx
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Nerve conduction studies
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Tx
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Fast HY Review 