Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Shoulder & Elbow
INTRODUCTION
&
BACKGROUND
The History is usually the
most important step to a
correct Diagnosis
L Funk
HISTORY
EXAMINATION
INVESTIGATIONS
DIAGNOSIS
...
• Be Systematic:
– Pain
– Function
• Loss of Movement (stiffness/weakness)
• Instability
– Swelling
– Systemic History
L F...
L Funk
L Funk
Traumatic / Non-traumatic
The importance of understanding the mechanism
of injury can not be underestimated - it gives clues to the
personality of t...
Non-Trauma
Onset
• When and how did the symptoms start?
• How has it changed?
• Have you had this before?
L Funk
Introductions
1. How ya doin’? - Introduction
2. What are you doing here? - Main Complaint
3. Have you been before?...
L Funk
Introduction

How ya Doin’?
Patients are People Too!!
• Shake Hands
• Introduce yourself Clearly and your Position
...
Main Complaint

Why are you here?
1. Pain
2. Function
– Loss of movement
– Instability / Locking
3. Swelling / Lump
L Funk
PAIN
• Site – where exactly is the pain?
• Radiation – Does it go anywhere else?
• Nature – Can you describe the pain?
• S...
PAIN
• Localised
• Referred
• Radicular
L Funk
PAIN
• Nociceptive Pain
– Local Tissue damage
– Worse with movement
– Opiates or NSAIDs
• Neurogenic Pain
– Peripheral Ner...
Function
• Activities of Daily Living
– ADL
• Sports / Recreation
• What can’t you do that you used to be able to do?
• Wh...
Function
1. Loss of Movement
2. Instability
L Funk
Loss of Movement
• Time of Loss of Movement
• Was there a dislocation?
• Are Active and Passive movements the same?
• Stif...
Instability
• Does the joint ‘Give Way’?
– Has it ever given way?
• Does the joint lock?
– What does the patient mean by t...
SWELLING
L Funk
• Has there been swelling?
• How much?
• How soon / how long?
• Has it changed?
• Related Features
– Pain
...
Past Medical History

Have you been before?
• Musculoskeletal
– Previous similar symptoms
– Other joints
– Arthritides
– R...
L Funk
Past Medical History

Have you been before?
• Social
– Work
– Sports / Hobbies
– Driving
– Live Alone
– Stairs
– Wa...
Mnemonic
L Funk
M OI/ onset
P ain
F unction
F eeling / Sensation
W eakness
S welling
S tiffness & Stability
M ust
P ass
F ...
20 year old male
Dislocated his left shoulder playing rugby
Ongoing Instability …
20 year old male
Dislocated his left shoulder playing rugby
Ongoing Instability …
1. Onset:
1. Exact
Mechanism
of Injury
2...
58 year old Female
Insidious onset shoulder pain 2 months ago
Pain extremely severe and unable to sleep
58 year old Female
Insidious onset shoulder pain 2 months ago
Pain extremely severe and unable to sleep
1. Onset:
1. Gradu...
58 year old Female
Fell 3 months ago injuring shoulder
Normal x-rays, but still painful and
struggling with gardening & ho...
58 year old Female
Fell 3 months ago injuring shoulder
Normal x-rays, but still painful and struggling with gardening
& ho...
72 year old Farmer
Elbow pain for 2 years
Increasing in severity
72 year old Farmer
Elbow pain for 2 years
Increasing in severity
Considerations: Arthritis (most likely); Epicondylitis;
B...
Case 5
21 year old Rugby player
Fell onto outstretched hand
Felt a clunk
Very painful medial side of elbow
Case 5
21 year old Rugby player
Fell onto outstretched hand
Felt a clunk
Very painful medial side of elbow
1. Onset:
1. Ex...
Case 6
18 year old female
Right handed
Keen tennis player
Painful & clicking right scapula
No recollection of injury
Case 6 18 year old female
Right handed
Keen tennis player
Painful & clicking right scapula
No recollection of injury
1. On...
Thank You
Lennard Funk, 2015
Upcoming SlideShare
Loading in …5
×

History Taking Case Examples Shoulder and Elbow

5,473 views

Published on

History Taking of the shoulder and elbow with case examples for the MSc Orthopaedics at University of Salford

Published in: Health & Medicine
  • DOWNLOAD FULL. BOOKS INTO AVAILABLE FORMAT, ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y8nn3gmc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

History Taking Case Examples Shoulder and Elbow

  1. 1. Shoulder & Elbow
  2. 2. INTRODUCTION & BACKGROUND
  3. 3. The History is usually the most important step to a correct Diagnosis L Funk HISTORY EXAMINATION INVESTIGATIONS DIAGNOSIS 60% 90% 100%
  4. 4. • Be Systematic: – Pain – Function • Loss of Movement (stiffness/weakness) • Instability – Swelling – Systemic History L Funk
  5. 5. L Funk
  6. 6. L Funk Traumatic / Non-traumatic
  7. 7. The importance of understanding the mechanism of injury can not be underestimated - it gives clues to the personality of the fracture and the treatment required: • When and how did the incident occur? • What exactly happened to the limb? • How much force was applied? • Has the joint ever been injured before? Trauma Mechanism of Injury
  8. 8. Non-Trauma Onset • When and how did the symptoms start? • How has it changed? • Have you had this before?
  9. 9. L Funk Introductions 1. How ya doin’? - Introduction 2. What are you doing here? - Main Complaint 3. Have you been before? – Past Medical History L Funk 4. Anything else?
  10. 10. L Funk Introduction
 How ya Doin’? Patients are People Too!! • Shake Hands • Introduce yourself Clearly and your Position L Funk
  11. 11. Main Complaint
 Why are you here? 1. Pain 2. Function – Loss of movement – Instability / Locking 3. Swelling / Lump L Funk
  12. 12. PAIN • Site – where exactly is the pain? • Radiation – Does it go anywhere else? • Nature – Can you describe the pain? • Severity – How bad is the pain? • Duration – How long have you had the pain? • Frequency – How often do you get the pain? • Aggravating factors – What makes the pain worse? • Relieving Factors – What makes the pain better? • Related Features – do you get any other symptoms? L Funk
  13. 13. PAIN • Localised • Referred • Radicular L Funk
  14. 14. PAIN • Nociceptive Pain – Local Tissue damage – Worse with movement – Opiates or NSAIDs • Neurogenic Pain – Peripheral Nerve or Nerve Root damage – Pain >> Tissue damage – Often Sensory changes – Poor response to Opiates or NSAIDs L Funk
  15. 15. Function • Activities of Daily Living – ADL • Sports / Recreation • What can’t you do that you used to be able to do? • Why? – Stiffness – Weakness – Pain L Funk
  16. 16. Function 1. Loss of Movement 2. Instability L Funk
  17. 17. Loss of Movement • Time of Loss of Movement • Was there a dislocation? • Are Active and Passive movements the same? • Stiff or Loose • Symptoms of Neurological deficit? • Symptoms of Tendon rupture? L Funk
  18. 18. Instability • Does the joint ‘Give Way’? – Has it ever given way? • Does the joint lock? – What does the patient mean by this? • Does the joint click or clunk? L Funk
  19. 19. SWELLING L Funk • Has there been swelling? • How much? • How soon / how long? • Has it changed? • Related Features – Pain – Function
  20. 20. Past Medical History
 Have you been before? • Musculoskeletal – Previous similar symptoms – Other joints – Arthritides – Rheumatic Fever – TB L Funk • Systemic – Cardiac – Respiratory – GIT – GUT – Drugs – Alcohol – Tobacco
  21. 21. L Funk Past Medical History
 Have you been before? • Social – Work – Sports / Hobbies – Driving – Live Alone – Stairs – Walking Aids – Assistance • Family History – Musculoskeletal • Anaesthetic – Previous – Problems
  22. 22. Mnemonic L Funk M OI/ onset P ain F unction F eeling / Sensation W eakness S welling S tiffness & Stability M ust P ass F ***ing F inals W ith S ome S tudying
  23. 23. 20 year old male Dislocated his left shoulder playing rugby Ongoing Instability …
  24. 24. 20 year old male Dislocated his left shoulder playing rugby Ongoing Instability … 1. Onset: 1. Exact Mechanism of Injury 2. Able to continue playing? 3. Management - relocated on pitch/hospital 4. Ease of relocation 2. Pain: 1. when 2. where 3. Nature of pain 4. Associated symptoms 
 (clicking, locking, instability) 3. Function: 1. Able to play? 2. Able to train (what training)? 3. If not, why? (pain, weakness or instability) 4. ADL 4. Instability: 1. When 2. What position(s) / Activity 3. Disloc / Sublux / Loose 4. Clicking / Locking 5. Associated pain? Considerations: Labral tear; capsular tear; fracture; rotator cuff tear; laxity; other joints
  25. 25. 58 year old Female Insidious onset shoulder pain 2 months ago Pain extremely severe and unable to sleep
  26. 26. 58 year old Female Insidious onset shoulder pain 2 months ago Pain extremely severe and unable to sleep 1. Onset: 1. Gradual / Sudden 2. Worsening / improving / no change 3. Previous similar? 2. Pain: 1. when 2. where 3. Nature of pain 4. Associated symptoms 
 (clicking, locking, instability) 5. Relieving factors 3. Function: 1. ADL 2. Sleep 3. Work 4. Recreation Considerations: Calcific tendonitis (most likely); Frozen Shoulder; ACJ Arthritis; Degenerative cuff tear; Tumour; Infection; Radicular origin
  27. 27. 58 year old Female Fell 3 months ago injuring shoulder Normal x-rays, but still painful and struggling with gardening & housework
  28. 28. 58 year old Female Fell 3 months ago injuring shoulder Normal x-rays, but still painful and struggling with gardening & housework Considerations: Rotator cuff tear; Greater tuberosity fracture; Post-traumatic Frozen Shoulder NOT Labral injury! 1. Onset: 1. Exact Mechanis m of Injury 2. Able to continue with ADL? 3. Management at the time 2. Pain: 1. when 2. where 3. Nature of pain 4. Associated symptoms 3. Function: 1. ADL 2. Sleep 3. Recreation 4. Work
  29. 29. 72 year old Farmer Elbow pain for 2 years Increasing in severity
  30. 30. 72 year old Farmer Elbow pain for 2 years Increasing in severity Considerations: Arthritis (most likely); Epicondylitis; Biceps/Triceps Tendonitis 1. Onset: 1. Gradual / Sudden 2. Worsening / improving / no change 3. Previous similar? 2. Pain: 1. when 2. where 
 (lateral/ medial) 3. Nature of pain 4. Associated symptoms 
 (clicking, locking, instability) 5. Relieving factors 3. Function: 1. ADL 2. Sleep 3. Work 4. Recreation
  31. 31. Case 5 21 year old Rugby player Fell onto outstretched hand Felt a clunk Very painful medial side of elbow
  32. 32. Case 5 21 year old Rugby player Fell onto outstretched hand Felt a clunk Very painful medial side of elbow 1. Onset: 1. Exact Mechanism of Injury 2. Able to continue playing? 3. Management - ? dislocated / subluxed - ? relocated on pitch/hospital 4. Ease of relocation 2. Pain: 1. when 2. where 3. Nature of pain 4. Associated symptoms 
 (clicking, locking, instability) 3. Function: 1. Able to play? 2. Able to train (what training)? 3. If not, why? (pain, weakness or instability) 4. ADL 4. Instability: 1. When 2. What position(s) / Activity 3. Disloc / Sublux / Loose 4. Clicking / Locking 5. Associated pain? Considerations: 
 Traumatic instability; fractures
  33. 33. Case 6 18 year old female Right handed Keen tennis player Painful & clicking right scapula No recollection of injury
  34. 34. Case 6 18 year old female Right handed Keen tennis player Painful & clicking right scapula No recollection of injury 1. Onset: 1. Gradual / Sudden 2. Worsening / improving / no change 3. Previous similar? 2. Pain: 1. when 2. where 3. Nature of pain 4. Associated symptoms 
 (clicking, locking, instability) 5. Relieving factors 3. Function: 1. ADL 2. Sleep 3. Work 4. Recreation 4. Other: 1. Other joints 2. Family Hx 3. Spinal Considerations: Snapping Scapula; Scapula Dyskinesis; Secondary to GHJ Instability; Hyperlaxity; Overhead Athlete
  35. 35. Thank You Lennard Funk, 2015

×