Elsevier: Goodman & Snyder: Differential Diagnosis for Physical Therapists Screening for Referral|| Chapter 18 (Answer Key)

1. A 66-year-old woman has been referred to you by her physiatrist for preprosthetic training after an above-knee amputation. Her past medical history is signifcant for chronic diabetes mellitus (insulin dependent), coronary artery disease with recent angioplasty and stent placement, and peripheral vascular disease. During the physical therapy evaluation, the client experienced anterior neck pain radiating down the left arm. Name (and/or describe) three tests you can do to differentiate a musculoskeletal cause from a cardiac cause of shoulder pain.

• Orthopedic evaluation: Palpate structures of the shoulder, including trigger point assessment; perform special orthopedic tests such as Yergason’s, apprehension test, relocation test, and Speed’s test; perform neurologic screening examination, including reflex testing, coordination, manual muscle testing, and sensory testing; screen for mechanical dysfunction above and below (temporomandibular joint, cervical spine, elbow).
• Systemic evaluation: Assess the effects of stair climbing or stationary bicycle riding (using only the lower extremities) on shoulder pain; assess for associated signs and symptoms (e.g., dyspnea, fatigue, palpitations, diaphoresis, cough, dizziness), and perform a systems review; measure vital signs on both sides.

2. Which of the following would be useful information when evaluating a 57-year-old woman with shoulder pain?

a. Influence of antacids on symptoms
b. History of chronic NSAID use
c. Effect of food on symptoms
d. All of the above

3. Referred pain patterns associated with impairment of the spleen can produce musculoskeletal symptoms in:

a. The left shoulder
b. The right shoulder
c. The mid- or upper back, scapular, and right shoulder areas
d. The thorax, scapulae, right or left shoulder

4. Referred pain patterns associated with hepatic and biliary pathology can produce musculoskeletal symptoms in:

a. The left shoulder
b. The right shoulder
c. The mid or upper back, scapular, and right shoulder areas
d. The thorax, scapulae, right or left shoulder

5. The most common sites of referred pain from systemic diseases are:

a. Neck and hip
b. Shoulder and back
c. Chest and back
d. None of the above

6. A 28-year-old mechanic reports bilateral shoulder pain (right more than left) whenever he has to work on a car on a lift overhead. It goes away as soon as he puts his arms down. Sometimes, he has numbness and tingling in his right elbow going down the inside of his forearm to his thumb. The most likely explanation for this pattern of symptoms is:

a. Angina
b. Myocardial ischemia
c. Thoracic outlet syndrome
d. Peptic ulcer

7. A client reports shoulder and upper trapezius pain on the right that increases with deep breathing. How can you tell if this results from a pulmonary or a musculoskeletal cause?

a. Symptoms get worse when lying supine but better when right sidelying when it is pulmonary
b. Symptoms get worse when lying supine but better when right sidelying when it is musculoskeletal

8. Organ systems that can cause simultaneous bilateral shoulder pain include:

a. Spleen
b. Heart
c. Gallbladder
d. None of the above

9. A 23-year-old woman was a walk-in to your clinic with sudden onset of left shoulder pain. She denies any history of trauma and has only a past history of a ruptured appendix three years ago. She is not having any abdominal pain or pain anywhere else in her body. How do you know if she is at risk for ectopic pregnancy?

a. She is sexually active, and her period is late.
b. She has a history of uterine cancer.
c. She has a history of peptic ulcer.
d. None of the above.

10. The most signifcant red flag for shoulder pain secondary to cancer is:

a. Previous history of coronary artery disease
b. Subscapularis trigger point alleviated with trigger point therapy
c. Negative neurologic screening exam
d. Previous history of breast or lung cancer

ANSWER KEY