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Meenakshi Aggarwal MD PGY2 Family Medicine AAFP Journal Review March 20th, 2008. Discussion. Chronic Shoulder Pain Evaluation Diagnosis Treatment Testicular Cancer Diagnosis
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PGY2 Family Medicine
AAFP Journal Review
March 20th, 2008
Fwd Flex - Deltoid, Pec maj, Coracobrach, Biceps
Extension -Deltoid, Teres maj, Teres min, Lat dorsi,
Abduction - Deltoid, Supraspin, Infraspin, Subscap,
Adduction - Pec maj, Lat dorsi, Teres maj, Subscap
Int rotation - Pec maj, deltoid, Lat dorsi, Subscap
Ext Rotation - Infraspin, Deltoid, Teres min
Location of the pain
Factors aggravating the pain
Hawkin’s Impingement Test - Indicates rotator cuff tear or tendinopathy
Raise arm to 160 degrees. Patient is then asked to slowly lower
the arm to the side. Positive test: Inability to control the lowering
phase and dropping of the arm.
Positive test is indicated by weakness
compared with the other side.
Indicates supraspinatus tear or
Cross Body Adduction Test:
Shoulder is passively adducted
across the body. Pain may indicate
AC joint pathology including chronic
sprain or OA.
Arm is abducted to 90 degrees and
shoulder flexed to 90 degrees. Pain
and sense of instability with further
ER may indicate shoulder
Ext Rotation/ Infraspinatus
Arms are held to the side
with elbows flexed to 90 deg,
Positive test is inability to ext
rotate against resistance.
Indicates infraspinatus or TM
tear or tendinopathy
* TOC: Test of choice
Q) Which one of the following statements about glenohumeral instability is correct?
A. Onset typically occurs in patients older than 40 years.
B. There is usually no history of subluxation or dislocation.
C. There may be a history of a "dead arm" or numbness over the lateral deltoid on physical examination.
D. There is usually no history of trauma or collision sports.
Q) Which one of the following statements about adhesive capsulitis is correct?
Patients not responding to treatment within one month should be referred for surgical intervention.
B. Subacromial steroid injections have been shown to improve long-term outcomes.
C. The natural history of the condition is to improve spontaneously after one to two years.
D. Pain medication should be withheld to the greatest extent possible, given the chronic nature of the condition.
Patient places the index and middle fingers under the testicle with the thumbs placed on top. Patient should roll the testicle gently between the thumbs and fingers feeling for lumps. Patient shouldn't feel any pain when doing the exam.
Q) Which one of the following is the preferred initial diagnostic test for a patient with a scrotal mass?A. Magnetic resonance imaging.B. Computed tomography.C. Ultrasonography.D. Positron emission tomography.
Q) Which one of the following statements about the clinical diagnosis of testicular cancer is correct?
Intra testicular masses should be considered testicular cancer until proved otherwise.
B. Pain on palpation rules out malignancy.
C. Most patients present with symptoms of metastatic disease.
D. Scrotal swelling is uncommon.