Lectures Musculoskeletal Care for the General Doctor: Shoulder and Knee Pain - C. Christopher Smith, MD

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Lectures Musculoskeletal Care for the General Doctor: Shoulder and Knee Pain presented the history, causes of discrimination by age, location of pain and the other history factors, the legal test visit clinical examination, initial treatment, ... This is a useful reference for readers and researchers studying their specialized medicine.

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Nội dung Text: Lectures Musculoskeletal Care for the General Doctor: Shoulder and Knee Pain - C. Christopher Smith, MD

Musculoskeletal Care for the General Doctor: Shoulder and Knee Pain C. Christopher Smith, MD, FACP Associate Professor of Medicine, Harvard Medical School Beth Israel Deaconess Medical Center Harvard Medical School
Disclosure of Financial Relationships C. Christopher Smith, MD Have no relationships with any entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on patients. Harvard Medical School
The Painful Shoulder and Knee Recognize, diagnose and treat the most common causes of shoulder and knee pain in the primary care setting Know how to differentiate among other common causes of shoulder and knee pain Harvard Medical School
The Painful Shoulder and Knee Anatomy History Differential based on patient’s age, location of pain and other historical elements Physical exam maneuvers Initial treatment Harvard Medical School
Shoulder Pain Harvard Medical School
A 65-year-old woman with a history of type II DM presents for evaluation of new left shoulder pain. The pain is in her anterior and lateral shoulder and has gradually worsened over the last three weeks. It is dull and constant and keeps her up at night. She also notices marked discomfort when she combs her hair and cannot get clothes from a high shelf due to pain and weakness. She denies any trauma or prior injuries. She works as a shop keeper. Harvard Medical School
Anatomy of the Shoulder UpToDate, 2006 Harvard Medical School
Harvard Medical School
The Rotator Cuff Muscles UpToDate, 2006 Harvard Medical School
Causes of Shoulder Pain Acromioclavicular Instability Osteoarthritis Impingement Syndrome Adhesive Capsulitis Systemic Inflammatory Biceps Tendonitis Disorders Brachial Plexus Neuritis Referred Pain - Diaphragmatic, Cervical Radiculopathy Subdiaphragmatic and Glenohumeral Arthritis Intrathoracic Causes Harvard Medical School
In the primary care setting, what is the most common cause of nontraumatic shoulder pain? A. Bicipital Tendonitis B. Impingement Syndrome C. Adhesive Capsulitis (Frozen Shoulder) D. Osteoarthritis of the Glenohumeral Joint E. Acromioclavicular Joint Osteoarthritis Harvard Medical School
In the primary care setting, what is the most common cause of nontraumatic shoulder pain? A. Bicipital Tendonitis B. Impingement Syndrome C. Adhesive Capsulitis (Frozen Shoulder) D. Osteoarthritis of the Glenohumeral Joint E. Acromioclavicular Joint Osteoarthritis Harvard Medical School
Causes of Shoulder Pain in the Primary Care Setting: Impingement Syndrome > 70% Adhesive Capsulitis 12% Bicipital Tendonitis 4% A/C Joint OA 7% Other 7% Harvard Medical Smith, J Gen Intern Med, 1992 School
So what is impingement syndrome? Harvard Medical School
Impingement Syndrome UpToDate, 2006 Harvard Medical School
Typical History of Impingement Syndrome Any age, but risk increases with age Anterior or lateral shoulder pain Pain exacerbated by abduction and forward flexion Night pain common Harvard Medical School
Age and Shoulder Pain Young (< 30 y.o.) • Dislocations/Instability of Glenohumeral Joint • Separation of AC joint • Overuse injury Less Young (30-60 y.o.) • Impingement Syndrome • Adhesive Capsulitis (especially in diabetics) • Separation/Overuse as above Older (> 60 y.o.) • Impingement Syndrome (non-traumatic tears) • Adhesive Capsulitis • Systemic Conditions (if bilateral, PMR, RA) Harvard Medical School
Physical Exam Inspection Palpation ROM • Difference between passive and active Pain active > passive ROM likely soft tissue disorder Pain equal with active and passive ROM likely intra- articular process Strength and Sensation Specific Maneuvers to Confirm Diagnosis Harvard Medical School
Maneuvers to Verify Impingement Syndrome Harvard Empty Can Test Medical School
Maneuvers to Verify Impingement Syndrome Harvard Neer’s Test Medical School Neer, Clin Orthop 1983