Extremity

  • Shoulder Pain
  • Knee Pain
  • Elbow Pain

Shoulder Pain

  • Differentials 
    • Non-traumatic/chronic
      • Subacromial bursitis
      • Biceps tendinitis
      • Adhesive capsulitis
      • Impingement syndrome
      • Calcific tendinitis
    • Traumatic/acute
      • Shoulder dislocation
      • Clavicle fracture
      • Humerus fracture
      • Scapula fracture
      • Acromioclavicular joint injury
      • Rotator cuff tear
      • Biceps/triceps tendon rupture
      • Septic Joint
    • Referred Pain/Non-orthopedic
      • Brachial plexus injury
      • Thoracic outlet syndrome
      • Myocardial infarction
      • Pulmonary embolism
      • Axillary artery thrombosis
      • Subclavian Steal Syndrome
  • History
    • Recent injury?
      • Likely acute process
    • Hear a pop/snap?
      • Consider fracture
    • Recent seizure?
      • Consider dislocation
    • Pain radiate to the elbow?
      • Consider cervical disc disease
    • Clunking sound w/ overhead motion?
      • Labral disorder
  • Physical Exam
    • Deformity
      • Suggests dislocation/fracture
    • Apley scratch test
      • Suggests rotator cuff problem
    • Neer’s Sign
      • Suggests subacromial impingement
    • Hawkin’s test
      • Suggests supraspinatus tendon impingement
    • Drop arm test
      • Suggests rotator cuff injury
  • Work-Up
    • Labs 
      • CBC, BMP, ESR, CRP
    • Procedures
      • Arthrocentesis (cell count culture, crystals, gram stain)
    • Imaging
      • Shoulder X-rays (2-3 view)
Video Credit: The Center for Medical Education

*Deep Dive: Shoulder Pain in the Urgent Care (JUCM)

Knee Pain

  • Differentials 
    • Orthopedic/Trauma
      • Bursitis
      • Osteoarthritis
      • Hemarthrosis
      • Ligament tear (ACL, PCL, MCL, LCL)
      • Meniscus injury
      • Fracture
      • Dislocation
    • Infectious
      • Septic joint
      • Reactive arthritis
      • Osteomyelitis
      • Septic bursitis
    • Crystalline
      • Gout
      • Pseudogout
    • Other
      • Tumor
      • Deep Venous Thrombosis
      • Baker’s Cyst
  • History
    • Recent injury?
      • Consider traumatic process
    • Hear a pop or snap?
      • Consider fractures or ligament/meniscal injury
    • Fever/Chills?
      • Consider infectious process
    • History of smoking, OCP’s, prolonged immobility?
      • Consider DVT
  • Physical Exam
    • Recent injury
      • Likely traumatic process
    • Warm, swollen, erythematous
      • Gout vs septic joint
    • Recurrent knee effusion
      • Suggests meniscus injury
    • (+) Anterior drawer or (+) Lachman
      • Suggests ACL injury
    • (+) Posterior sag sign
      • Suggests PCL injury
    • Pain w/ Varus stress
      • Suggests LCL injury
    • Pain w/ Valgus stress
      • Suggests MCL injury
  • Work-Up
    • Labs
      • CBC, BMP, ESR, CRP
    • Procedures
      • Arthrocentesis (cell count, culture, gram stain, crystals, protein, glucose, lactate)
    • Imaging
      • Knee X-rays (2-3 view)
Video Credit: Dr. Nabil Ebraheim

*Deep Dive: Occult Knee Injuries: Pearls and Pitfalls (EM Cases)

Elbow Pain

  • Differentials 
    • Anterior
      • Anterior capsule strain
      • Biceps tendinopathy
      • Gout
      • Intra-articular loose body
      • Osteoarthritis
      • Pronator syndrome
      • Rheumatoid arthritis
    • Lateral
      • Lateral epicondylitis
      • Osteochondral defect
      • Plica
      • Posterolateral rotatory instability
      • Radial Tunnel Syndrome
    • Medial
      • Medial epicondylitis
      • Ulnar collateral ligament injury
      • Cubital tunnel syndrome
    • Posterior
      • Olecranon bursitis
      • Olecranon stress fracture
      • Osteoarthritis
      • Triceps tendinopathy
      • Posterior impingement
  • History
    • Exact location of most pain
      • Narrow differentials based on location
    • Recent trauma?
      • Consider fracture, dislocation, etc.
    • Play sports? (tennis, golf, etc.)
      • Consider lateral/medial epicondylitis
    • Prolonged resting on the elbow?
      • Consider olecranon bursitis
    • Fever/Chills?
      • Consider septic arthritis
  • Physical Exam
    • (+) Elbow abduction stress test or Milking maneuver
      • Suggests ulnar collateral ligament injury
    • (+) Hook test
      • Suggests distal biceps tendon rupture
    • (+) Middle finger test
      • Suggests posterior interosseous nerve compression syndrome
    • (+) Tinel test
      • Suggests cubital tunnel syndrome
  • Work-Up
    • Labs
      • CBC, BMP, ESR, CRP
    • Procedures
      • Arthrocentesis (cell count, culture, gram stain, crystals, protein, glucose, lactate)
    • Imaging
      • Elbow X-ray series
Video Credit: The Center for Medical Education

*Deep Dive: Elbow Injuries: Ten Pitfalls in Diagnosis and Management (EM Cases)

Brandon Simpson, PA-C
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