Screening Shoulder and Upper Extremity

A 23-year-old woman was a walk-in to your clinic with sudden onset of left shoulder pain. She denies any history of trauma and has only a past history of a ruptured appendix 3 years ago. She is not having any abdominal pain or pain anywhere else in her body. How do you know if she is at risk for ectopic pregnancy? a. She is sexually active, and her period is late. b. She has a history of uterine cancer. c. She has a history of peptic ulcer. d. None of the above

a. She is sexually active, and her period is late.

A client reports shoulder and upper trapezius pain on the right that increases with deep breathing. How can you tell if this results from a pulmonary or musculoskeletal cause? a. Symptoms become worse when lying supine, but better when right sidelying if the cause is pulmonary b. Symptoms become worse when lying supine, but better when right sidelying if the cause is musculoskeletal

a. Symptoms become worse when lying supine, but better when right sidelying if the cause is pulmonary

Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in: a. The left shoulder b. The right shoulder c. The mid- or upper back, scapular, and right shoulder areas d. The thorax, scapulae, right or left shoulder

a. The left shoulder

Renal pain is -Usually _____ and _____ -But can be a severe, boring type of pain

achy and dull

Watch for systemic symptoms such as -Swelling 1+ joints -Early morning stiffness -Recurring pain and tenderness -Inability to move a joint normally -Obvious redness and warmth -Unexplained weight loss, fever, weakness -Symptoms > 2 weeks when considering _______ causes of shoulder pain

rheumatic

what are the most likely infectious causes for shoulder pain?

septic arthritis osteomyelitis Mono

Renal and ureteral pain is typically felt in the posterior ____?

subcostal and costovertebral regions (flank).

where does the central portion of the diaphragm refer pain?

upper trap neck supraclavicular fossa

Think _________ or systemic cause when shoulder pain is accompanied by: -Pleuritic component -Exacerbation by recumbency -Recent history of laparoscopic procedure (risk factor) -Exacerbation by exertion w/o shoulder movement (cardiac) -Coincident diaphoresis (cardiac)

viscerogenic

The therapist should look for -history of previous ulcer-NSAID usage-Symptoms 2 to 4 hours after taking the NSAID -Effect of eating when considering ______ causes of shoulder pain

gastrointestinal

The musculoskeletal symptoms associated with _____ and ____ pathologic conditions are generally confined to the -Midback-Scapular-Right shoulder regions.

hepatic biliary

Shoulder pain in a female of childbearing age of unknown cause associated with missed menses could indicate

(Rupture of ectopic pregnancy)

Shoulder pain relieved by leaning forward, kneeling with hands on the floor, sitting upright could indicate

(pericarditis)

Always end each client interview with what question?

-Do you have any symptoms of any kind anywhere else in your body that we haven't talked about yet?

MI associated Shoulder pain should be unaffected by ?

-Position-Breathing-Movement

Pain of cardiac and diaphragmatic originate from ___ _____ spinal segment

C5-C6

A 66-year-old woman has been referred to you by her physiat-rist for preprosthetic training after an above-knee amputation. Her past medical history is significant for chronic diabetes mel-litus (insulin dependent), coronary artery disease (CAD) with recent angioplasty and stent placement, and peripheral vascular disease. During the physical therapy evaluation, the client expe-rienced anterior neck pain radiating down the left arm. Name (and/or describe) three tests you can do to differentiate a mus-culoskeletal cause from a cardiac cause of shoulder pain.

Orthopedic evaluation: Palpate structures of the shoulder, including trigger point assessment; perform special orthopedic tests such as Yergason's, apprehension test, relocation test, and Speed's test; perform neurologic screening examination, including reflex testing, coordination, manual muscle testing, and sensory testing; screen for mechanical dysfunction above and below (temporomandibular joint, cervical spine, elbow). Systemic evaluation: Assess the effects of stair climbing or stationary bicycle riding (using only the lower extremities) on shoulder pain; assess for associated signs and symptoms (e.g., dyspnea, fatigue, palpitations, diaphoresis, cough, dizziness), and perform a systems review; measure vital signs on both sides.

Organ systems that can cause simultaneous bilateral shoulder pain include: a. Spleen b. Heart c. Gallbladder d. None of the above

b. Heart

The most common sites of referred pain from systemic disease are: a. Neck and hip b. Shoulder and back c. Chest and back d. None of the above

b. Shoulder and back

RA presents usually (bilateral or unilateral)

bilateral

Referred pain patterns associated with hepatic and biliary pathology can produce musculoskeletal symptoms in: a. The left shoulder b. The right shoulder c. The mid or upper back, scapular, and right shoulder areas d. The thorax, scapulae, right or left shoulder

c. The mid or upper back, scapular, and right shoulder areas

A 28-year-old mechanic reports bilateral shoulder pain (right more than left) whenever he has to work on a car on a lift over-head. It goes away as soon as he puts his arms down. Sometimes, he has numbness and tingling in his right elbow going down the inside of his forearm to his thumb. The most likely explanation for this pattern of symptoms is: a. Angina b. Myocardial ischemia c. Thoracic outlet syndrome d. Peptic ulcer

c. Thoracic outlet syndrome

where does the peripheral portion of the diaphragm refer to?

costal margins and lumbar region

Which of the following would be useful information when eval-uating a 57-year-old woman with shoulder pain? a. Influence of antacids on symptoms b. History of chronic NSAID use c. Effect of food on symptoms d. All of the above

d. All of the above

The most significant red flag for shoulder pain secondary to cancer is: a. Previous history of coronary artery disease b. Subscapularis TrP alleviated with TrP therapy c. Negative neurologic screening examination d. Previous history of breast or lung cancer

d. Previous history of breast or lung cancer

irritation of the peritoneal (outside) or pleural (inside) surface of the _____ refers sharp pain

diaphragm

The upper urinary tract can refer pain to the (contralateral or ipsilateral) shoulder on the same side as the involved kidney.

ipsilateral

diaphragm pain is (contralateral or ipsilateral) to the area of irritation

ipsilateral

The _____ lies in the posterior upper abdominal cavity in the retroperitoneal space, touching the diaphragm,

kidney

abnormal muscle wasting -Greater than expected with arthritis and follows a -Non-myotomal pattern may indicate _____ causes of shoulder pain

oncological

sharp, localized pain-aggravated by respiration-alleviated by lying on the affected side are symptoms of?

pleural irritation

______ in the older adult may appear as shoulder pain when the affected lung presses on the diaphragm. •The therapist should look -Persistent or productive cough and/or chest pain -Tachypnea -Dyspnea -Wheezing -Hyperventilation -Other noticeable changes.

pneumonia