Shoulder Pain

Shoulder Pain Mind Map

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Shoulder Pain by Mind Map: Shoulder Pain

1. Non-MSK Disorders (Red Flags)

1.1. Tumor

1.1.1. Signs and Symptoms Hx of cancer Unexplained weight loss Pain not caused by mechanical stress No relief with rest Night pain Unexplained mass, swelling, or deformity

1.1.2. Examples Osteosarcoma Bone Ewing Sarcoma Children's adolescent bones Chondrosarcoma Connective Tissue Pancoast Tumor Upper lobe of the lung

1.2. Visceral Disorders

1.2.1. Cardiac Intense angina Pain Chest Left Arm Left Neck

1.2.2. Peptic Ulcer Irritation of the diaphragm (phrenic nerve of C3-C5) by gastric juices Referral pattern Right anterior/lateral border

1.2.3. Cholecystitis (Gall Bladder) Accompanied with gall stones and abdominal pain Referral pattern Right shoulder Between scapula Subscapular Space Symptoms Pain after a fatty meal Gallstones Feeling of fullness Naseau, vomiting, loss of appetite since shoulder pain

1.2.4. Liver Disease Hepatitis Cirrhosis Metastatic Tumors Referral Patterns Right Shoulder Suprascapular Area

1.2.5. Spleen Rupture Usually traumatic Referral Pattern Left Shoulder

1.2.6. Pancreas Possibility of cancer Referral Pattern Left Shoulder

1.2.7. GI Discoloration of urine Blood in stool Symptoms worse after eating Recent vomiting Changes in bowel/bladder habits Specific foods make symptoms worse

1.3. Rheumatoid Arthritis/Polymyalgia Rheumatica

1.3.1. RA is very common

1.3.2. Often associated

1.3.3. RA Symptoms

1.3.4. PR Symptms Shoulder and hip pain Morning stiffness Malaise

2. MSK Referred Pain

2.1. Typically in superior or posterior aspects of the shoulder

2.1.1. Cervical Cervical Facet Joints Thoracic Periscapular Cervical Radiculopathy Periscapular

2.1.2. Thoracic Mid-back

2.2. Symptoms

2.2.1. Pain in shoulder with cervical movement Is pain with the neck seperated or connected with pain in the shoulder?

3. Traumatic Shoulder Pain

3.1. MOI:

3.1.1. Fall

3.1.2. Blunt Trauma

3.1.3. Sudden Loading/Eccentric Contractions

3.2. Humeral Fracture

3.2.1. Neers Scale Dependent on anatomical locations Greater tuberosity Lesser Tuberosity Humeral Head Humeral Shaft The lower the number, the lower the need for surgery

3.2.2. Non-Operative Sling 4-6 weeks Treatment Early Later

3.2.3. Operative Be careful of bone/tissue healing and initiating care Treatment Early Late

3.2.4. No difference in outcomes at 2 years with op v non-op or with early v. late mobilizations

3.3. GH Dislocations

3.3.1. GH and ANTERIOR Displacement

3.4. GH Seperation

3.4.1. AC and INFERIOR displacement

3.5. RTC Tear

3.5.1. see RTC

3.6. Tendon Tear

4. Atraumatic Shoulder Pain

4.1. Bony

4.1.1. GH OA Typically have a prior injury High association with RTC/Labral damage and GH OA Risk Factors Primary Secondary Signs/Symptoms Crepitus Pain in the morning that lessens with activity Atrophy Crepitus Cartilage defects

4.1.2. AC degeneration

4.1.3. Bone Stress Injuries

4.2. Soft-Tissue

4.2.1. RTC Signs Shoulder rides high on x-rays Variability in symptoms Hirn-blowers sign Know type of surgery Through the subscapularis Operative Total Shoulder Arthroplasty Reverst Total Shoulder Arthroplasty Non-Operative Medications Corticosteroid Injections Physical Therapy

4.2.2. Labral disorders

4.2.3. Frozen Shoulder

5. Post-Operative Conditions

5.1. Sub-acromial decompression

5.2. RTC repair

5.2.1. see RTC

5.3. Labral repair

5.4. Humeral ORIF

5.5. Shoulder Arthroplasty

5.5.1. Can be a standard or a reverse TSA, reverse is typically used with RTC complications, TSA Respect subscapularis guidelines if needed Sling for first 3-8 weeks Full Shoulder ROM by week 8 Start with isometrics and CKC and progress to progressive loading RTSA Benefit from pre-hab Sling use 4-6 weeks Full shoulder PROM and deltoid/scap resistance test by week 6 limitations of flexion and ER early Perform PROM early, watch out for limits set by physician with AROM isometrics early, progress to progressive loading weeks 6-8 Respect subscapularis guidelines if needed

5.5.2. Physical Therapy Start with PROM Progress to AROM/Strengthening

6. Additional Factors

6.1. Degree of sensitization

6.1.1. Hyperalgesia Increased response to noxious stimuli

6.1.2. Allodynia Increased nociceptive response to normal stimuli

6.1.3. Sensitivity to cold

6.2. Consider stage of the disorder

6.3. Consider tissue healing capacity

6.3.1. 1. Bone

6.3.2. 2. Muscle

6.3.3. 3. Tendon

6.3.4. 4. Ligament

6.4. Consider psychosocial factors

6.5. Consider lifestyle factors

6.6. Chester et al

6.6.1. 3 worse factors for prognosis 1. High pain at rest 2. Low pain self-efficacy (catasprophizing pain) 3. Low expectations for recovery