Differential diagnosis headache made easy with mnemonics. Identify the possible causes of anterior shoulder pain. The differential diagnosis is broad and can be aided by the primary location of the pain. Jul 31, 20 shoulder pain is a common complaint amongst patients presenting to physical therapy for an initial evaluation. N eck and shoulder pain are common presenting symptoms in the general adult population with a 41. Three questions are used as the conceptual basis for a diagnosisbased clinical decision rule in the management of mechanical and nonmechanical. Most shoulder pain is due to the structure supporting the shoulder joint. Process and endresult of evaluating information obtained from the examination, which the clinician then organizes into defined. What is anterior shoulder paincausessymptomstreatment.
Herbert stevenson, md, university of massachusetts. Osteoporotic vertebral fracture should always be considered within the. This single patient case report describes the use of these three questions in the differential diagnosis of shoulder and arm pain. A diagnostictherapeutic injection of 40 mg of triamcinolone and 4 ml of 1% xylocaine without epinephrine was administered into the right. Here is the differential diagnosis of neck pain with mnemonics. At the evaluation he reported sudden onset of pain earlier in the week, a high fever, and instruction to go to the er by his physician. Screening for visceral disease is important for several reasons, including the following. Shoulder pain is a common complaint amongst patients presenting to physical therapy for an initial evaluation. Know the causes, symptoms, treatment, exercises and diagnosis of anterior shoulder pain.
Patients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. Shoulder pain is a common problem in outpatient medical practice. The challenge for the physician evaluating shoulder. Differential diagnosis of shoulder pain followed by progressive weakness. Common causes of nonacute shoulder pain, listed in order from the most to the least common, include rotator cuff impingement, tendinosis, and. Instability common age 10 35 yrs physio if atraumatic refer to shoulder clinic instability traumatic dislocation ongoing symptoms atraumatic with failed physio primary care is the pain localised to the ac joint and associated with tenderness. Objectives identify the possible causes of anterior shoulder pain.
Differential diagnosis with mechanical diagnosis and. In children acute neck pain is usually due to an infectious process in the nasopharynx, the central nervous system, or the lymph nodes. You must check the presence of tendon on neck and motion of neck that aggravates or relieve the pain. Equally common is the subjective statement from the patient that heshe has no idea of how or why the shoulder pain came on in the first place. Pain with disc test shoulder lesion clinical signs test. Findings on imaging that affect likelihood of this diagnosis. Colicky abdominal pain no bowel motions or flatus distended, tender abdomen tinkling bowel sounds axr. This may not be the complete list of references from this article.
Shoulder pain is a common musculoskeletal complaint that may be due either to intrinsic disorders of the shoulder or referred pain. Evaluation of shoulder pain mdedge family medicine. Differentiating anterior shoulder pain in the overhead athlete. Start studying differential diagnosis of the shoulder. Differential diagnosis of shoulder and cervical pain. Get a printable copy pdf file of the complete article 157k, or click on a page image below to browse page by page. Differentiating anterior shoulder pain in the overhead athlete angela t. Full text is available as a scanned copy of the original print version.
Despite the diverse nomenclature used to describe fss, all of these terms denote different clinical conditions that may cause. Disorders of the upper cervical spineoa joint c23 zygapophysial joints facet joints are often associated with suboccipital pain, whereas. Painful shoulder motion with subdeltoid and subacromial bursitis, especially with abduction and extension. He had occasional neck pain over the past few years without any episodes of radiating pain from the cervical region into the shoulder or.
A new patient called for an appointment due to the onset of shoulder pain. Pain experienced in a somatic portion of the body secondary to organ irritation due to shared somatic and visceral innervation e. How to selfdiagnose your shoulder pain breaking muscle. Neck pain is a common complaint of patients presenting to a primary care office. In the differential diagnosis of neck pain, consideration may be taken of the patients age, the manner of onset and the duration of the pain, the severity of the pain, and the general condition of the patient. However, repeated neck movements demonstrated the ability to worsen and improve the shoulder pain and limitations.
A 44yearold male was referred with a diagnosis of shoulder impingement syndrome. Findings on physical exam that affect likelihood of this diagnosis. Appendicitis occasion4 i the abdomen table 11 differential diagnosis of right upper quadrant pain 1. Shoulder pain differential diagnosis orthopaedicsone. Nondominant shoulder more common in diabetics and more resistant to treatment keys to diagnosis early pain in all planes of motion later mechanical restriction of passive rom easiest to feel as tethering of er at the side xrays normal. Treatment of shoulder pain can be successfully managed by a primary care provider. Mdt was an effective tool at making the differential diagnosis between genuine and referred shoulder pain.
Full text full text is available as a scanned copy of the original print version. Impingement tendinopathy, bursitis, pasta age usually 3555. Shoulder pain is common in general practice and is a condition that. Chest pain syndrome is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest pressure.
Differential diagnosis of neck pain jama jama network. Different conditions may affect the stabilizing structures of the shoulder and, thus, negatively affect patients with shoulder dislocations. Differential diagnosis of rotator cuff, frozen shoulder. Pain is gradual and can develop over a few weeks or months. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Equally common is the subjective statement from the patient that heshe has no idea of how or why the shoulder.
Adjunct associate professor of bioengineering, department of mechanical and materials. It also supports the clinical utility of the mckenzie assessment as one approach in making this differential diagnosis. Department of rehabilitation medicine, dongguk university ilsan hospital. Early differential diagnosis is important, as emerging interventions show promise when used earlier in the disease process. Each of the three questions for differential diagnosis was addressed, and clinical tests and examination findings were used to differentiate the origin of the patients symptoms. Herniated disk discogenic neck pain axial neck pain whiplash associated disorder wad radiculopathy cervical myelopathy shoulder disorder compression fracture osteoarthritis, eg, cervical spondylosis seen on xray osteomyelitis deep neck infection, eg, ludwigs angina subarachnoid hemorrhage meningitis migraine neoplasm e. Shoulder bursitis shoulder pain differential diagnosis.
Interrupted sleep with an increase in pain with rolling onto the affected shoulder. Slaven and mathers differential diagnosis of shoulder and cervical pain journal of manual and manipulative therapy 2010 vol. In this case, an appropriate diagnosis led to improvement in the management strategy of what might have appeared to be unrelated shoulder pain. Adhesive capsulitis and frozen shoulder syndrome fss are 2 terms that have been used to describe an array of clinical conditions, including subacromial bursitis, calcifying tendinitis, and partial rotator cuff tears. Adhesive capsulitis frozen shoulder differential diagnoses. Shoulder pain differential diagnosis orthopaedicsone articles. Differential diagnosis of the overhead athlete labrum vs trp weakness use of tdn to reproduce pain treatment at same time stability tests obrien sulcus relocation clunk regional interdependence vs biceps tendonitis any history of cervical dysfunction referred pain vs local pain histological changes from changes in axonal.
Evaluation and outline management of atraumatic anatomy. Jul 18, 20 a 44yearold male was referred with a diagnosis of shoulder impingement syndrome. Is the pain localised to the ac joint and associated with tenderness. Even when a fracture has occured, many patients are without evident clinical symptoms. Differential diagnosis osteoarthritis rheumatoid arthritis avascular necrosis. Differential diagnosis and treatment of visceral pain in.
The evaluation and management of the patient with chest pain syndrome is a diagnostic challenge to all who practice emergency medicine. Differential diagnosis of neck pain mnemonics med syndicate. Shoulder dislocations may occur from a traumatic injury or from loose capsular ligaments. At the er the patient was left waiting for nearly 12 hours and after examination he was prescribed pain medication and sent home.
The challenge for the physician evaluating shoulder pain is the myriad of etiologies and the potential for multiple disorders. Differential diagnosis of knee pain november 11, 2016. Shoulder tip pain may have spotting tenderness riflif guarding. Differential diagnosis of common shoulder pain koreamed synapse. The case report highlights the importance of differentiating shoulder pain that is from the shoulder from cervical referred pain, despite many factors suggesting the opposite. Links to pubmed are also available for selected references. Findings on history that affect likelihood of this diagnosis. This may indicate the mechanical problem of the neck. In this condition the rotator cuff is unable to support the glenohumeral joint thereby causing pain in the biceps and the shoulder. Differential diagnoses for the cervicothoracicshoulder region laurie edgehughes, bscpt, manimst, cafci, ccrt. Differential diagnoses for the cervicothoracicshoulder.
Gordon pt, dsc, mpt, comt, ocs, atc stacy soapmann pt, dsc, faaompt. Pdf differential diagnosis of shoulder and cervical pain. In general, osteoporosis is not associated with back pain until a vertebral fracture has occurred. Approximately 10% to 15% of the worlds population suffer from an episode of neck pain at any time and 40% of the population will suffer from neck pain over a 12month period. Compounding the challenge is a lack of uniformity in the literature regarding diagnostic classification.
Abstractpatients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. Visceral referred pain to the shoulder an important component of the initial orthopedic evaluation is the differentiation of the causes of the patients pain complaints between a musculoskeletal origin and a visceral pathologic condition or disease. During examination and evaluation of the patient, the physical therapist must consider all potential causes of the patients symptoms. The former include injuries and acute or chronic degeneration or inflammation of the shoulder joint, tendons, surrounding ligaments, or periarticular structures. Differentiating anterior shoulder pain in the overhead. During examination and evaluation of the patient, the physical. Differential diagnosis of the overhead athlete labrum vs trp weakness. In this article, you will able to remember the differential diagnosis and all other related stuff regarding a headache with mnemonics. Apr 06, 2018 the anterior shoulder pain usually develops when injury or inflammation occurs in the tendons that are attached to the shoulder joint. Review imaging findings relevant to these causes of pain and. Condition findings on history that affect likelihood of this diagnosis findings on physical exam that affect likelihood of this diagnosis findings on imaging that affect likelihood of this diagnosis experience teaches impingement tendinopathy, bursitis. Differential diagnosis of the shoulder flashcards quizlet. A case report 17 his past medical history included a few episodes of stingers while playing rugby in college over 10 years ago.
Differential diagnosis and management of ankylosing. The anterior shoulder pain usually develops when injury or inflammation occurs in the tendons that are attached to the shoulder joint. Shoulder painis it from the shoulder, neck, or both. The working diagnosis was external shoulder impingement with a differential diagnosis of internal impingement andor cervical radiculopathy.
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