- 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
- Non-traumatic/chronic
- 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
- Recent injury?
- 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
- Deformity
- Work-Up
- Labs
- CBC, BMP, ESR, CRP
- Procedures
- Arthrocentesis (cell count culture, crystals, gram stain)
- Imaging
- Shoulder X-rays (2-3 view)
- Labs
*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
- Orthopedic/Trauma
- 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
- Recent injury?
- 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
- Recent 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)
- Labs
*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
- Anterior
- 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
- Exact location of most pain
- 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
- (+) Elbow abduction stress test or Milking maneuver
- Work-Up
- Labs
- CBC, BMP, ESR, CRP
- Procedures
- Arthrocentesis (cell count, culture, gram stain, crystals, protein, glucose, lactate)
- Imaging
- Elbow X-ray series
- Labs
*Deep Dive: Elbow Injuries: Ten Pitfalls in Diagnosis and Management (EM Cases)
Latest posts by Brandon Simpson, PA-S2 (see all)