Shoulder Pain Patterns

Question 1

what is the common referral pattern for the GHJ? (6)

Answer 1

1. pain deep anterior or posterior
2. pain at deltoid insertion
3. arm band usually worse laterally
4. referral along C5 dermatome (usually less severe distally)
5. index finger and thumb paresthesia
6. supraspinous fossa/neck (uncommon)

Question 2

what is the common referral pattern for the ACJ? (5)

Answer 2

1. local pain over joint, anterior more common
2. pain along clavicle
3. pain into neck
4. pain is a thin line into bicep (rare)
5. C4 dermatome referral

Question 3

what is the common referral pattern for the AHJ? (2)

Answer 3

1. pain under the acromion

2. may spread up or down

Question 4

what is a common referral pattern for the SCJ? (2)

Answer 4

1. local pain

2. spreads up or across but never down

Question 5

what is a common referral pattern for subdeltoid bursitis? (3)

Answer 5

1. subacromial pain
2. palpable with heat and swelling
3. acute - pain with any movement

Question 6

what is a common referral pattern for the STJ?

Answer 6

1. under the shoulder blade

2. sufficient trauma affecting neck

Question 7

what causes triceps pain?

Answer 7

usually not shoulder; instead, can be lower Cx, upper T, or STJ

Question 8

how could you tell that posterior shoulder symptoms are being caused by the posterior capsule?

Answer 8

1. +ER resisted

2. posterior capsule stretch

Question 9

if anterior shoulder symptoms… think… (2)

Answer 9

1. biceps tendon

2. anterior capsule or labrum

Question 10

strong and painful resisted shoulder testing suggests what?

Answer 10

classical contractile lesion or false positive for bursitis

Question 11

how do you distinguish between a contractile lesion and bursitis?

Answer 11

bursitis - resisted abduction and ER will be less painful with distraction

Question 12

what does weak and painful tell you?

Answer 12

classical acute RTC tear or false positive for capsule inflammation - less likely would be a fracture or neoplasm

Question 13

how do you distinguish between an acute RTC tear and capsule inflammation

Answer 13

inflamed capsule - passive testing will be MORE painful than resisted testing

Question 14

what does weak and painless tell you?

Answer 14

1. complete RTC tear
2. neuro problem
3. false positive for instability

Question 15

how do you determine if a weak and painless problem is instability?

Answer 15

stabilize the GHJ and retest strength. if strength improves then GHJ instability