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Case Studies- Shoulder

Terms in this set (24)

Pt. is a swimmer who comes in with shoulder pain. She has EDEMA and INFLAMMATION of the shoulder. She's been experiencing acute pain that is now becoming chronic. She reports sharp catches of pain, grating, and weakness when lifting the arm overhead. Upon examination you note that the SUPRASPINATUS tendon is involved.
Rotator Cuff Tendinitis
Pt. is a 45 y/o baseball pitcher that complains of pain when arm is flexed. Upon an examination, you notice the pt. has weakness, atrophy of of the supraspinatus and infraspinatus muscles with pain and tenderness. When you ask the pt. to abduct and forward flex the gleno-humeral joint, they are severally impaired. Pt. shows positive "DROP-ARM" test.
Rotator Cuff Tear.
Pt. comes in with acute, disabling attacks of shoulder pain. She holds her arm close to her side, and all motions are severely limited by pain. Upon examination, tenderness is maximal below the tip of the acromion. The subacromial bursa (which overlies the supraspinatus tendon) is inflamed.
Calcific Tendinitis (a degenerative process in the tendon associated w/the deposition of calcium salts.) Occurs more commonly in WOMEN and over the age of 30
Pt. comes in with complaint of shoulder pain. Upon examination you ask the pt. to supinate forearm against resistance. Pt. has increased pain in the bicipital groove.
Bicipital Tendinitis (usually resembles or co-exists with Rotator Cuff Tendinitis)
Pt. complains of diffuse, dull, aching pain in shoulder and progressive restriction of active and passive ROM. The condition is UNILATERAL. The pt. has had previous myocardial infarction. This pain has been CHRONIC.
Adhesive Capsulitis (Frozen Shoulder)-a fibrosis of the glenohumeral joint capsule. Condition is unilateral and occurs in people aged 50-70 y/o
Pt. was playing basketball and fell on his shoulder "twenty years ago". He now has LOCALIZED tenderness over the acromioclavicular joint. Shoulder shrugging is painful (scapula movement).
Acromioclavicular Arthritis--uncommon, usually arising from direct injury to the shoulder girdle with resulting degenerative changes. Most common type of shoulder arthritis.
Pt. complains of shoulder pain after he pitched his last ball during baseball. He said, it felt like "the shoulder slipped out". Any shoulder movement causes pain, and the pt. is holding his arm in a NEUTRAL position. The shoulder also seems flattened, rather than "rounded".
Anterior Dislocation of the Humerus--shoulder instability from anterior dislocation of the humerus. Usually results from a fall or forcefull throwing motion. Shoulder slips out when the arm is abducted and externally rotated, causing a "Positive Apprehension Sign".
Pt. is a 53 y/o female assembly line worker. Pt. c/o anterior and lateral neck pain and chest and left arm pain that has lasted three weeks. Cardiac tests are negative. Adson's Test and Allen's Test are positive.
Thoracic Outlet Syndrome.
Pt. displays weakness of the DELTOID muscle and upper arm with shoulder pain and numbness.
Cervical radiculopathy- C5
Pt. displays weakness of BICEPS and wrist muscles with numbness on the thumb side of the hand.
Cervical radiculopathy- C6
Pt. is a 52 y/o male tennis player with progressive subdeltoid aching that is aggravated by shoulder ABD/elevation or sustained overhead activity. Pain radiates into the lateral upper arm.
Supraspinatus Impingement. Caused by rotator cuff overload or muscle imbalance. Mean onset 50-59, more frequent in diabetic patients or athletes whose sports involve throwing or overhead motions.
Pt. displays weakness in hand grip with numbness in the little finger.
Cervical Radiculopathy- C8
Pt. is a 50 y/o baseball coach who felt a "pop" in his neck while catching a ball. He has pain radiating from the left should blade, down the back of the arm into the thumb and index finger of his left hand. The pain is somewhat relieved when he stretches his arm overhead with the elbow bent. He has weakness in the left TRICEPS.
Cervical radiculopathy- C7
Pt. is a 23 y/o student who fell onto her right shoulder while biking around campus. She displays limited shoulder motion due to pain, swelling and bruising on the top of the shoulder and tenderness over the AC joint. A small bony bump is noted at the outer end of the clavicle.
Shoulder separation, Type III. Damage to the AC joint and injury to acromioclavicular (AC) and coracoclavicular (CC) ligaments. There are 6 classifications of injury, Type I (AC partial tear/CC ok), Type II (AC torn/possible CC tear or injury), Type III (AC torn/CC torn).
Pt. is a 27 y/o computer programmer. He plays in a sand volleyball league on the weekends. He presents with pain around the medial scapula with a feeling of crepitus around the scapula described as "grinding or popping".
Snapping Scapula Syndrome (Scapulothoracic Bursitis). Respond well to conservative treatment directed at improving posture and scapular position and movement with overhead activity.
Pt. is a 4o y/o motorcycle rider who traumatically dislocated her left shoulder 10 years ago which was corrected by arthroscopic surgery. Patient's symptoms include diffuse pain, swelling, and "locking" or "clunking" of the shoulder joint.
SLAP Type III, tear and/or degeneration of the superior labrum of the GH joint. Type I (Partial tear), Type II (Full tear/superior labrum torn off glenoid ), Type III (Full tear hanging in joint), Type IV (Full tear extending to long head of biceps).
Pt. presents with loss of shoulder abduction (from 15-90 degrees) and weak flexion, extension, and rotation of the shoulder as well as loss of sensation over a small part of the lateral shoulder. Specifically, there is decreased function of the teres minor and deltoid muscles.
Humeral surgical neck fracture with damage to the axillary nerve and posterior circumflex humeral artery. Most common type of proximal humeral fracture.
Pt. is a 26 y/o male involved in a MVA in which he sustained a left humeral fracture. The brachial artery was disrupted and required urgent attention in the OR. Pre-op Neuro eval demonstrated no motion of the ECRL, ECRB, EPB, ED, EIP, and EPL muscles.
Laceration or complete disruption of the radial nerve due to traumatic humeral fracture. The deep brachial artery (branch of brachial artery) may be damaged in midshaft humeral fractures.
Pt. is a 42 y/o male who fell six feet and landed on his right head and shoulder. He sustained a right humeral fracture and presents with total paralysis of the right arm (flaccid ipsilateral limb).
Nerve root avulsion C5 to T1. Injury to brachial plexus.
Pt. is seen post-op after a humeral ORIF using the posterior approach. What nerves could be impacted?
The posterior antebrachial cutaneous nerve, which branches from the radial nerve in the axilla.
Pt. is a 32 y/o male who presents to the ER with a humeral shaft fracture. He has wrist drop as well as impaired finger and thumb extension. Which motor function would be expected to recover last?
MCP hyperextension. Recovery of radial nerve function will proceed in a proximal to distal direction.
A 21 y/o college football player has been diagnosed with a left superior trunk brachial plexus injury following a tackle. What would be the clinical findings?
Superior trunk brachial plexus injuries are thought to occur when an athlete sustains a lateral flexion injury of the neck. Transient injuries are referred to as "stingers" or a "burner". Symptoms would be impairments to the sensory and motor functions of the axillary, musculocutaneous, and suprascapular nerves.
A 26 y/o male sustained a traction injury to the left arm after a motorcycle crash with resulting weakness of the left UE. Findings include Horner syndrome, a medially winged scapula, and loss of paraspinal muscle activity on EMG.
Pre-ganglionic injury to the brachial plexus. Normal cervical paraspinal muscle activity is characteristic of a post-ganglionic injury.
A 16 y/o male fell from a roof onto his right shoulder. He presents with decreased pulse in his right UE. Imaging reveals a posterior sternoclavicular dislocation. What structures would be impacted by this injury?
Complications of posterior dislocation can include respiratory distress, venous congestion or arterial insufficiency, brachial plexus compression, and myocardial conduction abnormalities. Reconstruction of the costoclavicular ligaments may be required.
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