UQ Clinical Reasoning

Night pain, painful arc (60–120°), symptoms improve with scapular correction, overhead athlete or deconditioned adult

Subacromial Impingement

Posterior shoulder pain during late cocking phase of throwing, negative classic impingement tests, GIRD present

Internal Impingement

Severe constant shoulder pain with rapid onset (1–2 days), marked tenderness, painful but noncapsular ROM

Bursitis

Dull ache with “warm-up effect,” full but painful ROM, strong MMT despite pain

RTC Tendinopathy

Weakness with ER and overhead activity, positive drop arm and ER lag, history of trauma or age >40

RTC Tear

Apprehension with abduction/ER, reports shoulder “slipping out,” excessive or guarded ROM

Shoulder Instability

Deep vague shoulder pain with clicking/catching, fatigue with overhead use (“dead arm”), decreased IR

SLAP Tear

History of anterior dislocation, anterior shoulder pain, fear/guarding with ER, instability with overhead motion

Bankart Lesion

Posterior shoulder pain with push-ups or bench press, decreased IR and horizontal adduction, negative apprehension

Posterior Labral Tear

Anterior shoulder pain localized to bicipital groove, worse with resisted elbow flexion/supination

Biceps Tendinopathy

Point tenderness directly over AC joint, pain with cross-body adduction, mechanism = fall onto shoulder

AC Joint Sprain

Medial clavicle pain radiating to chest/neck, pain with breathing or pushing/pulling, possible visible deformity

SC Joint Injury

Progressive loss of both PROM and AROM, ER most limited (>50% loss), firm capsular end feel, diabetic patient

Adhesive Capsulitis

Numbness/tingling in 4th and 5th digits (dorsal + palmar), worse with elbow flexion, intrinsic hand weakness

Cubital Tunnel Syndrome

Numbness in 4th/5th digits ONLY on palmar side, cyclist or prolonged wrist pressure

Guyon Canal Syndrome

No sensory loss, inability to make “OK” sign, weak pinch, deep anterior forearm ache

Anterior Interosseous Nerve Syndrome

Forearm pain with repetitive pronation, paresthesia in first 3 digits but NO night pain

Pronator Teres Syndrome

Finger drop with wrist extension preserved, no sensory loss

Posterior Interosseous Nerve Syndrome

Lateral elbow pain mimicking tennis elbow but no weakness or sensory loss

Radial Tunnel Syndrome

Lateral elbow pain with gripping, weak grip strength, pain with resisted wrist extension

Lateral Epicondylalgia

Medial elbow pain with wrist flexion/pronation, weak wrist flexors

Medial Epicondylalgia

Ulnar-sided wrist pain with clicking and inability to weight bear, worse with pronation/supination

TFCC Tear

Ulnar wrist pain after FOOSH with radial deviation, signs of instability (VISI)

Lunotriquetral Ligament Injury

Dorsal wrist pain, weak grip, crepitus, history of FOOSH with ulnar deviation

Scapholunate Instability

Pain at base of thumb after forced abduction, weak pinch strength

Gamekeeper’s Thumb

Finger stuck in flexion with drooped DIP after forced flexion injury

Mallet Finger

Inability to flex DIP after forced hyperextension, finger rests extended

Jersey Finger

Finger catching/locking in flexion with palpable nodule at MCP

Trigger Finger

Ulnar wrist pain at pisiform, worse with resisted flexion and ulnar deviation

FCU Tendinopathy

Dorsal ulnar wrist pain with snapping sensation during rotation or extension

ECU Tendinopathy

Radial wrist/thumb pain, worse with gripping, positive Finkelstein test

De Quervain’s Tendinopathy

Night pain, numbness/tingling in first 3 digits, thenar atrophy, dropping objects

Carpal Tunnel Syndrome

Night pain, painful arc, BUT significant weakness with ER and positive drop arm after a fall

RTC Tear

Night pain, painful arc, preserved strength, symptoms improve with scapular assistance test

Subacromial Impingement

Young overhead athlete with posterior pain only in late cocking, increased ER, decreased IR, negative Neer

Internal Impingement

Global loss of both AROM and PROM, ER most limited, firm capsular end feel, gradual onset over months

Adhesive Capsulitis

Painful shoulder with full PROM but limited AROM, weakness in ER, history of trauma

RTC Tear

Pain with overhead activity, clicking, and “dead arm” feeling, but apprehension test negative

SLAP Tear

Recurrent anterior dislocations, fear with ABD/ER, excessive ER ROM, positive relocation test

Anterior Instability (Bankart-related)

Posterior shoulder pain with push-ups, limited horizontal adduction, negative anterior apprehension

Posterior Labral Tear

Anterior shoulder pain localized to groove, worse with resisted elbow flexion, no instability

Biceps Tendinopathy

Point tenderness over AC joint, pain with horizontal adduction, normal glenohumeral ROM

AC Joint Sprain

Medial clavicle pain with breathing and coughing, pain with shoulder elevation, possible step deformity

SC Joint Injury

Severe acute shoulder pain with rapid onset and inability to move due to pain, diffuse tenderness

Bursitis

Weakness in ER and abduction, atrophy of supraspinatus, chronic symptoms, minimal pain

Chronic RTC Tear

Pain improves after initial reps (“warm-up effect”), full ROM but painful arc, strong resisted testing

RTC Tendinopathy

Apprehension with ABD/ER but full strength and no pain at rest

Shoulder Instability

Deep vague pain with clicking, worse with overhead throwing but minimal pain with ADLs

SLAP Tear

Posterior pain with follow-through phase of throwing, weakness in ER, decreased IR ROM

Posterior Labral Tear

Ulnar-sided wrist pain with clicking, worse with weight-bearing and pronation/supination

TFCC Tear

Dorsal wrist pain, weak grip, history of FOOSH with ulnar deviation, possible crepitus

Scapholunate Instability

Ulnar wrist pain after FOOSH with radial deviation, instability pattern (VISI)

Lunotriquetral Injury

Lateral elbow pain with gripping, worse with resisted wrist extension, decreased grip strength

Lateral Epicondylalgia

Lateral elbow pain but no weakness or sensory loss, deep aching, worse with resisted supination

Radial Tunnel Syndrome

Medial elbow pain with wrist flexion/pronation, weak wrist flexors, pain with stretch

Medial Epicondylalgia

Numbness in 4th/5th digits including dorsal hand, worse with elbow flexion

Cubital Tunnel Syndrome

Numbness in 4th/5th digits ONLY on palmar side, cyclist or prolonged wrist pressure

Guyon Canal Syndrome

No sensory deficits, weak pinch grip, cannot form “OK” sign

Anterior Interosseous Nerve Syndrome

Forearm pain with repetitive pronation, paresthesia in first 3 digits, NO night pain

Pronator Teres Syndrome

Night pain, numbness in first 3 digits, thenar atrophy, dropping objects

Carpal Tunnel Syndrome

Finger drop (cannot extend fingers) but wrist extension preserved

Posterior Interosseous Nerve Syndrome

Radial wrist pain at base of thumb, worse with gripping and lifting infant, positive Finkelstein

De Quervain’s

Ulnar wrist pain at pisiform, worse with resisted wrist flexion and ulnar deviation

FCU Tendinopathy

Dorsal ulnar wrist pain with snapping sensation during rotation

ECU Tendinopathy

Thumb pain after forced abduction, weak pinch, instability at MCP

Gamekeeper’s Thumb

Drooped fingertip after forced flexion injury, cannot actively extend DIP

Mallet Finger

Cannot flex DIP after forced hyperextension, finger rests extended

Jersey Finger

Finger locks in flexion with palpable nodule at MCP, painful release

Trigger Finger