MSK 3: Shoulder Red Flags

Primary/metastatic tumors: signs & sx

-deep, intense, unremitting, non-mechanical pain

-pain worse at night or at rest

-unexplained weight loss

-fever

-mass present

-lymphadenopathy

Primary/metastatic tumors: risk factors

-PMH of cancer

-smoker

-obesity

-alcoholism

-specific infections: HPV

-increasing age (>50)

-inherited genes

Osteosarcoma: signs & sx

-bone pain / pain around joint

-constant or more severe at night

-swelling/mass/deformity

-stiffness in joint

-fatigue

-most common at prox. Humerus

Osteosarcoma: risk factors

-hx of childhood cancer

-teens and ages>60 most common

-most common site is proximal humerus

Infections or septic arthritis: signs & sx

-constant pain

-sudden onset, ret, hot, pyrexia

-high inflammatory markers

-systemic sx

-fever (not always)

Infections or septic arthritis: risk factors

-PHM of RA or DM

-recent surgery or injection

-poor living conditions

-alcoholism or IVDU

-insect bite, trauma with wounds

AVN of humeral head: signs&sx

-pain which increases over time

-stiffness in jt

AVN of humeral head: risk factors

-trauma that damages blood supply

-steroid use (prednosolone)

-excessive alcohol consumption

-past radiation/chemo

-sickle cell anemia

-HIV

-commercial/military divers

Inflammatory arthropathy: signs & sx

-early morning joint stiffness >30 min

-persistent swelling of 1+ joints

-squeezing joint is painful

-bowel disease

-hx of psoriasis, iritis, enthesopathy

Inflammatory arthropathy: risk factors

-recent infection (bowel or genitourinary)

-inflammatory conditions

-caucasian

Polymyalgia rheumatica / giant cell arteritis: risk factors

-women>men between 70-80 years

-men more likely to suffer blinding

Polymyalgia rheumatica: signs & sx

-sudden onset (1-2 weeks), sometimes just after flu-like sx

-painful stiffness in shoulders and/or thighs and pelvic girdle (usually BIL)

-may feel unwell and have slight fever

-may lose weight

-tiredness

Giant cell arteritis: signs & sx

-20% of PMR patients develop GCA

-severe headaches, temple tenderness

-pain in jaw, tongue, side of head when chewing

-pain or swelling of scalp

-blurred/double vision

Fracture/dislocation: signs/sx

-deformity

-swelling, erythema, bruising

-neurovascular deficit

-muscle wasting

-difficulty WB

Fracture/dislocation: risk factors

-trauma

-pathological fx: osteoporosis, Paget's, multiple myeloma, PHM cancer

-insufficiency fx: low BMI, alcoholism, smoker

-risk for osteoporosis

-RED-S

Acute RTC tear: signs & sx, risk factors

-pain and weakness after trauma

-sudden loss of ability to raise arm (with or without trauma)

-risk: major trauma if young, minor trauma if old