Anatomy Condition Definition Presentation Examination
Positional asymmetry OP - asymmetry, tenderness
Torticollis Rotation & lateral flexion of head due to Cx muscle spasm Unequal ROM ROM - unilateral reduced A/PROM
With/without neck pain Ortho - shoulder depression, screen
OP - hypertonicity
Slowly progressive dull, achy neck pain
Progressive loss of articular cartilage, osteophyte formation, ROM - may be reduced, may be pain on either flexion (disc
Cervical DJD Morning stiffness
reduced disc height, loss of Cx lordosis herniation/damage) or extension (facet/IVF encroachment)
Aggravated by repetitive use
Ortho - distraction, compression
OP - head/neck tilt away from injury, Bakody's sign, paraspinal
Deep aching/burning pain in neck/arm tenderness, hypertonicity
Weakness in hand/arm ROM - reduced extension, rotation & lateral flexion. Pain on lateral
Cervical Radiculopathy Neuro-compressive disorder of cervical nerve roots (disc herniation)
Bakody's sign: symptoms reduced with the painful arm placed on flexion
top of head Ortho - Valsalva, compression, distraction, shoulder depression,
brachial plexus stretch
Insidious progression
Gait disturbance +/- clumsy hands
Lhermitte's sign: neck flexion causes electric shocks down the spine
Cervical Myelopathy Spinal cord injury due to severe pressure
Legs UMN & arms LMN signs
Loss of vibration & proprioception
Loss of sexual & B&B function
Cervical Spine
Dull, achy pain (sharp when acute) Observe, palpate - head leans away from pain, hypertonicity
(10) Cervical facet joint irritation/damage causing
Cervical Facet Syndrome Localised, pin-point pain ROM - extension/flexion pain
cranial/Cx/shoulder/back pain
Possible neck spasm Ortho - compression, distraction
Neck pain & potential radiation to occiput or shoulder/arm OP - local tenderness, spasm, hypertonicity
Whiplash ST damage to ligaments, muscles, discs or other CT Non-dermatomal ROM - reduced
Headache & possible tinnitus Ortho - distraction (local pain)
Jaw/facial/neck pain
Pain/tenderness due to TMJ dysfunction or surrounding OP - jaw asymmetry, hypertrophy, tenderness
TMJ Syndrome Pain on chewing & locking/catching
musculature ROM - reduced jaw opening (3 finger rule), clicking/popping
Headache & ear ache
New or sudden onset severe pulsitile headache OP - facial asymmetry, artery asymmetry
ST brain ischaemia causing focal neuro effects (10-20 min) with full Potential visual changes, speech disturbances & Neuro - MMSE, CN, SMR, cotton wool/pin prick, CAD
TIA
resolution in 24hr weakness/numbness Systems - BP, heart auscultation
Either ACA, MCA or PICA symptoms A&E referral via ambulance
New or sudden onset severe pulsitile headache
OP - gait, Bell's palsy, artery asymmetry
Potential visual changes, speech disturbances &
Stroke Permanent interruption of BF to part of the brain MMSE - MMSE, CN, SMR, Babinski
weakness/numbness
Emergency referral via ambulance
Either ACA, MCA or PICA symptoms
Neck stiffness without loss of ROM
OP - symptoms
BF reduction to basilar artery, typically due to compression 5D’s/3N’s + ataxia
VBAI Systems - BP, carotid auscultation
(atheroma) or tear (dissection) of the vertebral artery New or worst ever headache referring upwards from neck to
Neuro - CAD
occipital & forward
Pain at rest & at night, esp. when lying on affected side
Most common muscle of the rotator cuff to tear (rotator cuff = OP – tender to palpate
Pain/weakness with lifting arm
Rotator Cuff Tear - Supraspinatus supraspinatus, infraspinatus, teres minor, subscapularis = stabilise ROM – reduced, painful, weak
Acute tears = sudden severe pain
glenohumeral joint & allow deltoid to abduct arm) Ortho – Empty Can, Painful Arc, Drop Arm, Neer, Hawkins-Kennedy
Degenerative = progressive & arm weakness
Severe acute pain aggravated with any shoulder movement O – Px may hold their arm to avoid moving it
Rotator Cuff Formation of small calcium deposits within the rotator cuff tendons
Calcific Tendonitis Stiffness, snapping, catching or weakness P – subacromial bursa (passively extending the shoulder)
(most commonly supraspinatus)
May wake Px up from sleep ROM – restricted/painful A/PROM
Achy anterior shoulder pain aggravated by lifting or overhead
OP – bicipital groove tenderness
activities
Biceps Tendonitis Inflammatory process of the long head of the biceps tendon ROM – painful/weak resisted flexion
A complete rupture will cause the belly of the muscle to bulge (like
Ortho – Speeds, Yergasons, Neer's, instability assessment
Popeye)
Inflammation of the subacromial bursa which results in an increase Gradual onset deep superior shoulder pain OP – severe localised bursa tenderness, swelling
Subacromial Bursitis
in synovial fluid production Unable to lay on affected side ROM – painful, abduction & flexion limited
Sharp pain on abduction (90o GH, end range AC)
AC Joint OP – swelling, wasting, tenderness
Joint pain aggravated by exercise, relieved by rest
AC/GH Osteoarthritis Inflammation of the AC/GH joints due to ‘wear and tear’ of cartilage ROM – reduced & painful
Morning stiffness (<30 min)
Ortho – Dugas’, Neer’s
Swelling, crepitus, instability, muscle wasting
OP – visible structural deformity
Dislocation due to tearing of the local ligaments, most commonly Shoulder pops out of joint ROM – restricted to none
Glenohumeral Dislocation
anterior Extreme pain Ortho – Dugas’
Neuro – sensation loss axillary nerve
Point tenderness & swelling OP – pain, swelling, bruising, prominent clavicle
Dislocations Tearing of the local ligaments (AC ligament most commonly,
AC Dislocation Prominent distal clavicle ROM – reduced & painful
possibly coracoclavicular too)
Pain at night & when lying on affected side Ortho – Cross Body Abduction, Dugas's
OP – head tilt towards affected side, holding arm, deformity,
Chest & shoulder pain
SC Dislocation Dislocation due to tearing of the local ligaments tenderness
Aggravated by arm movement or laying supine
ROM – painful
OP – muscle mass asymmetry, tenderness
Shoulder Mechanical impingement of the rotator cuff tendon beneath the Hx repetitive use or trauma followed by a gradual increase in ROM –stiffness, abduction pain >90°
Rotator Cuff Impingement
anteroinferior acromion (subacromial impingement) shoulder pain with overhead activities Ortho – Dugas’ (may show AC pathology), Painful Arc, Empty Can,
(16)
Lift Off, Neer, Hawkins-Kennedy
Slow onset shoulder pain
Discomfort near the deltoid insertion
Unable to sleep on affected side OP – guarding shoulder, tenderness
Inflammatory
Reduced ROM ROM – reduced A/PROM (= diagnostic)
Adhesive Capsulitis Painful & significant restriction of shoulder AROM/PROM
3 progression phases, may take 2 years Ortho – Apley Sctratch, Painful Arc, SITS (hugely restricted or
1. Freezing – gradually more & more pain, reducing ROM impossible)
2. Frozen – pain may reduce, stiffness remains
3. Thawing – ROM slowly improves
Inflammation of the scapulothoracic bursitis which results in painful OP – crepitus, tenderness, audible snap, winging scapula
Scapulothoracic Bursitis Pain during overhead activities, crepitus with shoulder movement
snapping of the scapula ROM – normal with audible snapping/crepitus
OP – potential tenderness
Most common labral tear injuring both aspects of the joint & also Locking, popping or grinding
ROM – reduced/painful globally (esp. IR/ER & abduction)
SLAP Labral Tear possibly the biceps tendon (SLAP = superior labrum anterior & Pain with movement & lifting (esp. overhead)
Ortho – O’Brien’s, McCarthy, Log Roll, FADIR (Speeds, Anterior
posterior) Reduced strength & ROM, feeling of instability
Apprehension)
OP – Px hold arm if wary of stability
Generalised arm/shoulder pain with feeling of instability
ROM – bilateral guarding, but no restrictions
Shoulder Instability Generally bilateral, atraumatic condition, capsular laxity Aggravated by overhead activity, relieved by rest
Ortho – Drawer, Apprehension, possibly labral tests (FADIR, Log
Trauma Possible night pain
Roll, McCarthy, O'Briens)
OP – swelling, tenderness, visual deformity, cradling arm
Clavicle Fracture Fracture of the clavicle Pain, swelling & tenderness over the clavicle ROM – painful, reduced, guarding
Systems – lung sounds (risk of pneumothorax)
OP – tenderness, holding arm, unable to move, guarding
Pain, paraesthesia & weakness over the humerus ROM – severely reduced
Humeral Fracture Fracture of the humerus
Loss of function Ortho – tuning fork, percussion
Neuro – axillary nerve sensation changes
Proximal muscle pain of the shoulder +/- Hip girdles Vitals – low-grade fever
Inflammatory condition that causes muscle pain & stiffness, esp.
Systemic Polymyalgia Rheumatica Morning stiffness >1hr OP – tenderness, atrophy
shoulders/hips
Can be unilateral but becomes bilateral after a few weeks ROM – limited
OP - ant. head carriage, hypertonic SCM/scalenes, tender
scalenes/lower Cx/brachial plexus
Compression of brachial plexus by scalene muscles, 1st rib & Unilateral pain, numbness and/or paraesthesia (P&N) in neck,
Thoracic Outlet Syndrome (TOS) ROM - normal
clavicle (= thoracic outlet) shoulder & upper limb (commonly medial aspect)
Neuro - cotton wool & pin prick, muscle strength testing
Ortho - Roos, Adson’s, Halstead’s, Wright’s, Costoclavicular
OP - scapular winging during upright wall pushup
Neck/shoulder pain/spasm
Damage to the long thoracic nerve, from C5-C7, which innervates ROM - limited shoulder flexion (90) & abduction (110)
Long Thoracic Nerve Palsy Shoulder weakness
serratus anterior muscle Neuro - deltoid weakness
Scapular winging
Ortho - TOS tests
Sudden onset usualy in right shoulder (can be bilateral) OP - affected arm held as if in sling, muscle atrophy, pain
Acute brachial neuritis (inflammation of peripheral nerves) which
Parsonage Turner Syndrome Constant sharp/throbbing pain ROM - painful shoulder movements
results in pain & loss of function
Aggravated by shoulder movement Neuro - axillary numbness, shoulder weakness, a/hyporeflexia
Insidious onset (except when trauma)
OP - supraspinatus/infraspinatus atrophy
Vague posterolateral shoulder ache
Suprascapular Nerve Palsy Entrapment, compression or friction of suprascapular nerve ROM - weak abduction & IR
Worse with throwing
Neuro - axillary numbness, deltoid weakness
Infra/supraspinatus weakness
Intermittent paraesthesia in ring/small finger OP - claw hand
Elbow
A mononeuropathy causing entrapment of the ulnar nerve at the Clawing of digits & atrophy ROM - normal or weak RROM
Cubital Tunnel Syndrome (CuTS)
elbow Weak wrist flexion, ulnar deviation, finger flexion & finger Neuro - little finger numbness
ab/adduction Ortho - Tinel's, Wartenburg's, Elbow Flexion
OP - tenderness underneath lateral epicondyle
Tendinosis (tendon degeneration due to overuse without Pain over lateral elbow with radiation down posterior forearm
Lateral Epicondylitis (Tennis Elbow) ROM - painful supination/extension RROM
inflammation) of extensor carpi radialis brevis Worsens with activity, improves with rest
Ortho - Resisted Middle Finger Extension, Tinel's
OP - medial epicondyle tenderness
Tendinopathy (tendon injury) of interface between pronator teres Ache over medial elbow
Medial Epicondylitis (Golfer's Elbow) ROM - painful pronation/flexion RROM
and flexor carpi radialis origins Grip weakness
Ortho - Golfers Elbow, Tinel's, Ligament Instability
OP - lump/swelling, redness, warmth, pain/tenderness
Posterior elbow swelling, often painless
Olecranon Bursitis Inflammation of the olecranon bursa ROM - painful end range flexion
Fever (if infective)
Vitals - fever
