DIAGNOSTIC EVALUATION OF CERVICAL VS. SHOULDER PAIN: A PHYSIATRIST S PERSPECTIVE

Transcription

1 Russ Cantrell, M.D. Physical Medicine and Rehabilitation Orthopedic Sports Medicine and Spine Care Institute DIAGNOSTIC EVALUATION OF CERVICAL VS. SHOULDER PAIN: A PHYSIATRIST S PERSPECTIVE

2 PHYSIATRIST Physical Medicine and Rehabilitation Established as distinct specialty by ABMS in 1947 Non-surgical evaluation and treatment of musculoskeletal and neuromuscular conditions and injuries

3 DIFFERENTIAL DIAGNOSIS A systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible Essentially a process of elimination or at least of obtaining information that shrinks the probabilities to negligible levels

4 DIFFERENTIAL DIAGNOSIS Intuitive Human nature Medical school Emergency room Physician s office

5 NECK PAIN Carotid artery dissection Acute coronary syndrome Head or neck cancer Retropharyngeal abscess Myelopathy Cervical fracture Radiculopathy Spinal stenosis Osteoarthritis Postural abnormalities Muscular strain Facet joint sprain Overuse Degenerative disc disease Rheumatoid arthritis Shoulder ROM limitation Rotator cuff weakness Scapular muscle weakness Stress

6 SHOULDER PAIN Fracture Acute coronary syndrome Referred abdominal pain Dislocation Avascular necrosis AC degeneration AC sprain Impingement syndrome Rotator cuff tear Rotator cuff tendonitis Labral tear Cervical radiculopathy Biceps tendonitis Postural abnormalities Overuse Rotator cuff weakness Thoracic outlet syndrome Adhesive capsulitis Long thoracic neuropathy Suprascapular neuropathy

7 NECK PAIN Carotid artery dissection Acute coronary syndrome Head or neck cancer Retropharyngeal abscess Myelopathy Cervical fracture Radiculopathy Spinal stenosis Osteoarthritis Postural abnormalities Muscular strain Facet joint sprain Overuse Degenerative disc disease Rheumatoid arthritis Shoulder ROM limitation Rotator cuff weakness Scapular muscle weakness Stress

8 SHOULDER PAIN Fracture Acute coronary syndrome Referred abdominal pain Dislocation Avascular necrosis AC degeneration AC sprain Impingement syndrome Rotator cuff tear Rotator cuff tendonitis Labral tear Cervical radiculopathy Biceps tendonitis Postural abnormalities Overuse Rotator cuff weakness Thoracic outlet syndrome Adhesive capsulitis Long thoracic neuropathy Suprascapular neuropathy

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10 HISTORY Mechanism of onset Traumatic vs. non-traumatic Simultaneous vs. delayed onset Exacerbating features Associated symptoms

11 PHYSICAL EXAM Observation ROM Palpation Reflexes Muscle weakness Provocative tests

12 OBSERVATION

13 RANGE OF MOTION

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16 PALPATION

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18 REFLEXES

19 MUSCLE STRENGTH

20 C8 RADICULOPATHY VS. MFP

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23 CASE EXAMPLE 42 y.o. sanitation worker Acute onset shoulder pain and weakness after lifting heavy bag of trash Orthopedic evaluation and MRI revealed partial RCT with surgical recommendation IME rotator cuff weakness + biceps weakness + diminished biceps reflex Cervical MRI large HNP C 5-6 Outcome further conditioning without surgery and patient RTW regular duty

24 SUMMARY Assessment of shoulder pain shoulder include screening exam of the cervical spine Assessment of neck pain and/or upper extremity N/T/W should include screening exam of shoulder Complaints of N/T distally should always trigger consideration of cervical etiology in shoulder pain presentation Just because it quakes like a duck doesn t mean it s a duck