[Music] so I'm excited to talk to you about shoulder pain today it's one of the more common things I see in my practice and the interesting thing about shoulder pain is it really requires a good physical examination so we're gonna be discussing the epidemiology and differential diagnosis of common causes of shoulder pain today but we'll also spend a lot of time on physical exam and then therapeutics as well let's get underway and let's start with a case I've got a 50 year old right-handed woman she reports a four week history of right shoulder pain she works as a housecleaner and her shoulder feels worse after work a little bit more history she feels the shoulder has grown stiff in the past week and she tried seeing him in a fit and ibuprofen for a pain and they had a modest effect this isn't that a typical history right away notice a few things though in the history whenever you're talking about a unilateral symptom in the upper extremities always include whether the patient's right or left hand that's going to tell me something so maybe in my patients and working as a house cleaner she's vacuuming a lot or doing a lot of repetitive motion with that right arm because her dominant arm so always include her handedness as part of the history of present illness it's worse after work so that's not surprising there's a lot of inflammatory conditions that can be and then now her shoulder is growing stiff is that because it hurts so much or is it because she inherently is lacking range of motion of the joint and then it's important to know she's already tried to seat a min if an ibuprofen – obviously that's gonna inform us as we think about therapeutics for her so some things we want to know about that are elusive in this case what is the duration of pain how long has it been going on was there an inciting event such as a trauma it's going to be very different if you were tackled playing football versus you've noticed the pain slowly developing over the course of a month cleaning houses the degree of disability anytime we talk about musculoskeletal pain and really any type of pain should include an assessment for how disabled the patient is as well it's not just about treating the pain if this is interfering with her ability to do her job that interferes with her livelihood so that can become a lot more serious than just pain alone other joint pain you know shoulder pain in combination with other forms of pain could indicate some rare rheumatologic condition even more rarely some type of infection but if it's just sticking to her shoulder you can be pretty sure it's probably related in this case to overuse at work and then as I mentioned it can be hard to loose a just on history alone what is pain and what is truly in mobility of the arm because patients will use their upper extremity less as the pain increases which increases the sensation that they're not moving in as much so what are the major causes of shoulder pain to consider the major causes in my practice and all primary care include rotator cuff tendonitis adhesive capsulitis acromioclavicular joint disease biceps tendinitis and glenohumeral arthritis or instability those six the most common causes they account for the vast majority of cases in my practice [Music]



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