Shoulder Examination

Shoulder pain is commonly multifactorial in aetiology, especially in the elderly

• T

• F

Consider PMR in patients with bilateral shoulder pain

• T

• F

Referred pain from the neck can mimic shoulder pathology

• T

• F

Answer explanation

Shoulder pain can also be referred from other anatomical structures, such as the neck (cervical radiculopathy) or from visceral organs (e.g., myocardial infarction or gallbladder disease).

Rotator cuff disorders, such as tendinopathy and tears are the leading causes of shoulder pain. These conditions often result from overuse, aging and acute injuries. Which of these are true regarding rotator cuff disorders:

• It is worse at night, especially when lying on the affected shoulder, exacerbated by lifting or reaching overhead

• The "Belly Press Test" and the Lift Off Test : assesses subscapularis pathology

• Empty can test : pain or weakness indicates infraspinatus pathology

• External rotation resistance test: assesses infraspinatus and teres minor

• Over half of patients over 60 have aymptomatic rotator cuff tears and imaging can therefore be

  misleading

Answer explanation

Imaging for shoulder pain rarely adds to a careful history and examination, and is usually

unnecessary – however, investigations are appropriate in patients with red flags

Subacromial impingement syndrome occurs when the rotator cuff tendons are compressed under the acromion. This compression can lead to inflammation and pain. Which of these are related to subacromial impingement syndrome:

• Gradual, related to repetitive overhead activities

• Pain location anterolateral shoulder

• Worse with overhead activities and at night

• Positive Neer's sign

• Positive Hawkins-Kennedy Test

Frozen Shoulder - Adhesive capsulitis. Which statements are true?

• Global pain and restriction of both active and passive movements is highly suggestive of

  adhesive capsulitis

• Insidious, often following minor trauma or immobilisation

• Yergason's Test is a special test for adhesive capsulitis

• There is constant pain and progressive stiffness, worse at night

• Cross-body Adduction test is another special test for this condition

Answer explanation

• Yergason’s Test: Pain or snapping in the bicipital groove indicates tendinitis or instability.
  
  Cross-body Adduction Test: Pain indicates AC joint pathology. "Scarf test"

Glenohumeral osteoarthritis involves the degeneration of the cartilage within the shoulder joint, leading to pain, stiffness, and reduced range of motion. This condition is more common in older adults and those with a history of shoulder injuries. Which of these are true?

• Worse with activity, relieved by rest

• In additional to deep shoulder pain, associated symptoms include stiffness and crepitus

• Reduced active and passive ROM, with crepitus

• There are no specific tests for this condition but imaging (Xray) confirms diagnosis

Susan is a 55 year old accountant who complains of a 6 week history of left shoulder pain, especially when doing up her bra and reaching up to high shelves. What are the most important key features of history in helping to identify potential serious causes of her shoulder pain?

• Trauma

• History of malignancy

• Fevers

• Weight loss

• Night pain

Answer explanation

Neurological deficit is another important red flag to check for in history taking