Neck pain is a common complaint of patients presenting to a primary care office. A 44yearold male was referred with a diagnosis of shoulder impingement syndrome. The anterior shoulder pain usually develops when injury or inflammation occurs in the tendons that are attached to the shoulder joint. Patients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain.
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. Here is the differential diagnosis of neck pain with mnemonics. 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. Herbert stevenson, md, university of massachusetts. The challenge for the physician evaluating shoulder pain is the myriad of etiologies and the potential for multiple disorders. Is the pain localised to the ac joint and associated with tenderness. The evaluation and management of the patient with chest pain syndrome is a diagnostic challenge to all who practice emergency medicine. Differential diagnosis of acute chest pain oscestop. Differential diagnoses for the cervicothoracicshoulder. In this condition the rotator cuff is unable to support the glenohumeral joint thereby causing pain in the biceps and the shoulder. Links to pubmed are also available for selected references. A diagnostictherapeutic injection of 40 mg of triamcinolone and 4 ml of 1% xylocaine without epinephrine was administered into the right.
He had occasional neck pain over the past few years without any episodes of radiating pain from the cervical region into the shoulder or. N eck and shoulder pain are common presenting symptoms in the general adult population with a 41. I of a twopart article on clinical evaluation of the painful shoulder. Differential diagnosis with mechanical diagnosis and. It also supports the clinical utility of the mckenzie assessment as one approach in making this differential diagnosis. Full text is available as a scanned copy of the original print version. Disorders of the upper cervical spineoa joint c23 zygapophysial joints facet joints are often associated with suboccipital pain, whereas. Differential diagnosis with mechanical diagnosis and therapy extremity assessment e a case report. Differential diagnosis of common shoulder pain koreamed synapse. Findings on history that affect likelihood of this diagnosis. 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. 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.
Slaven and mathers differential diagnosis of shoulder and cervical pain journal of manual and manipulative therapy 2010 vol. Shoulder pain is a common musculoskeletal complaint that may be due either to intrinsic disorders of the shoulder or referred pain. The former include injuries and acute or chronic degeneration or inflammation of the shoulder joint, tendons, surrounding ligaments, or periarticular structures. Interrupted sleep with an increase in pain with rolling onto the affected shoulder. 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. During examination and evaluation of the patient, the physical therapist must consider all potential causes of the patients symptoms. Differentiating anterior shoulder pain in the overhead athlete angela t. The working diagnosis was external shoulder impingement with a differential diagnosis of internal impingement andor cervical radiculopathy. Differentiating anterior shoulder pain in the overhead. Differential diagnosis of knee pain november 11, 2016. Treatment of shoulder pain can be successfully managed by a primary care provider.
At the er the patient was left waiting for nearly 12 hours and after examination he was prescribed pain medication and sent home. Shoulder pain usually causes disability in activities of daily living, and therefore its proper diagnosis and management are. Despite the diverse nomenclature used to describe fss, all of these terms denote different clinical conditions that may cause. Shoulder pain is a common complaint amongst patients presenting to physical therapy for an initial evaluation. Differential diagnosis of the overhead athlete labrum vs trp weakness. 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. 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. Identify the possible causes of anterior shoulder pain. However, repeated neck movements demonstrated the ability to worsen and improve the shoulder pain and limitations. Shoulder dislocations may occur from a traumatic injury or from loose capsular ligaments.
Even when a fracture has occured, many patients are without evident clinical symptoms. Sep 18, 2018 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. Most shoulder pain is due to the structure supporting the shoulder joint. Department of rehabilitation medicine, dongguk university ilsan hospital. Pdf differential diagnosis of shoulder and cervical pain. Findings on imaging that affect likelihood of this diagnosis. Differential diagnosis of neck pain mnemonics med syndicate. Know the causes, symptoms, treatment, exercises and diagnosis of anterior shoulder pain.
Abstractpatients are frequently referred to physical therapy with the diagnosis of shoulder and arm pain. Differential diagnosis and management of ankylosing. Differential diagnosis of shoulder and cervical pain. Process and endresult of evaluating information obtained from the examination, which the clinician then organizes into defined. Visceral referred pain to the shoulder chirocredit. Three questions are used as the conceptual basis for a diagnosisbased clinical decision rule in the management of mechanical and nonmechanical.
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. 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. Pain with disc test shoulder lesion clinical signs test. Shoulder pain is common in general practice and is a condition that. Early differential diagnosis is important, as emerging interventions show promise when used earlier in the disease process. Shoulder pain differential diagnosis orthopaedicsone articles. Gordon pt, dsc, mpt, comt, ocs, atc stacy soapmann pt, dsc, faaompt. Common causes of nonacute shoulder pain, listed in order from the most to the least common, include rotator cuff impingement, tendinosis, and. Differential diagnosis of shoulder pain followed by. Differential diagnosis of rotator cuff, frozen shoulder. Compounding the challenge is a lack of uniformity in the literature regarding diagnostic classification.
Shoulder bursitis shoulder pain differential diagnosis. Apr 06, 2018 the anterior shoulder pain usually develops when injury or inflammation occurs in the tendons that are attached to the shoulder joint. What is anterior shoulder paincausessymptomstreatment. This may not be the complete list of references from this article. Jul 18, 20 a 44yearold male was referred with a diagnosis of shoulder impingement syndrome. 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. Impingement tendinopathy, bursitis, pasta age usually 3555. Differential diagnosis headache made easy with mnemonics. If your neck pain is older than 1 week you should immediately go to your physician. Appendicitis occasion4 i the abdomen table 11 differential diagnosis of right upper quadrant pain 1. 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. Differential diagnosis osteoarthritis rheumatoid arthritis avascular necrosis.
Differential diagnosis of shoulder pain followed by progressive weakness. Pain is gradual and can develop over a few weeks or months. Evaluation and outline management of atraumatic anatomy. The differential diagnosis is broad and can be aided by the primary location of the pain. Different conditions may affect the stabilizing structures of the shoulder and, thus, negatively affect patients with shoulder dislocations. Get a printable copy pdf file of the complete article 157k, or click on a page image below to browse page by page. 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. Review imaging findings relevant to these causes of pain and. A case report 17 his past medical history included a few episodes of stingers while playing rugby in college over 10 years ago. Painful shoulder motion with subdeltoid and subacromial bursitis, especially with abduction and extension. Start studying differential diagnosis of the shoulder. Findings on physical exam that affect likelihood of this diagnosis.
Jul 31, 20 shoulder pain is a common complaint amongst patients presenting to physical therapy for an initial evaluation. Shoulder pain differential diagnosis orthopaedicsone. Differential diagnosis of the shoulder flashcards quizlet. This may indicate the mechanical problem of the neck. Mdt was an effective tool at making the differential diagnosis between genuine and referred shoulder pain. Equally common is the subjective statement from the patient that heshe has no idea of how or why the shoulder. 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. Differential diagnoses for the cervicothoracicshoulder region laurie edgehughes, bscpt, manimst, cafci, ccrt. 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. Differentiating anterior shoulder pain in the overhead athlete. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Colicky abdominal pain no bowel motions or flatus distended, tender abdomen tinkling bowel sounds axr. Adjunct associate professor of bioengineering, department of mechanical and materials. Shoulder painis it from the shoulder, neck, or both. This single patient case report describes the use of these three questions in the differential diagnosis of shoulder and arm pain. Evaluation of shoulder pain mdedge family medicine. Differential diagnosis and treatment of visceral pain in. Objectives identify the possible causes of anterior shoulder pain. In general, osteoporosis is not associated with back pain until a vertebral fracture has occurred. Adhesive capsulitis frozen shoulder differential diagnoses. You must check the presence of tendon on neck and motion of neck that aggravates or relieve the pain. In children acute neck pain is usually due to an infectious process in the nasopharynx, the central nervous system, or the lymph nodes. Shoulder pain is a common problem in outpatient medical practice. Differential diagnosis of neck pain jama jama network. Full text full text is available as a scanned copy of the original print version.
Screening for visceral disease is important for several reasons, including the following. 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. In this case, an appropriate diagnosis led to improvement in the management strategy of what might have appeared to be unrelated shoulder pain. In this article, you will able to remember the differential diagnosis and all other related stuff regarding a headache with mnemonics.
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