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Research ArticleEvidence-Based Clinical Medicine

A Simplified Approach to Evaluate and Manage Shoulder Pain

Kartik Sidhar, Hyung Jin Lim and Laurel Gutierrez
The Journal of the American Board of Family Medicine November 2024, 37 (6) 1156-1166; DOI: https://doi.org/10.3122/jabfm.2024.240114R2
Kartik Sidhar
From the Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI (KS, LG); Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA (HJL).
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Hyung Jin Lim
From the Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI (KS, LG); Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA (HJL).
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Laurel Gutierrez
From the Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI (KS, LG); Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA (HJL).
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Article Figures & Data

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    Figure 1.

    Shoulder pain evaluation algorithm.

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    Figure 2.

    Normal supraspinatus tendon

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    Figure 3.

    Normal subscapularis tendon.

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    Figure 4.

    Normal biceps tendon.

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    Figure 5.

    Supraspinatus tendinosis.

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    Figure 6.

    Supraspinatus partial tear.

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    Figure 7.

    Biceps tendinosis.

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    Figure 8.

    Glenohumeral joint osteoarthritis.

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    Figure 9.

    Rotator cuff arthropathy.

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    Figure 10.

    Distal clavicle osteolysis.

Tables

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    Table 1.

    Shoulder Special Test Sensitivity and Specificity

    Shoulder Physical ExamRelevant Shoulder PathologySensitivity (95% CI)Specificity (95% CI)
    Hawkins61Subacromial impingement/Rotator cuff tendinopathy80% (0.72, 0.86)56% (0.45, 0.67)
    Neers61Subacromial impingement/Rotator cuff tendinopathy72% (0.60, 0.81)60% (0.40, 0.77)
    Painful arc62Subacromial impingement/Rotator cuff tendinopathy73.5%81.1%
    Infraspinatus muscle strength test62Subacromial impingement/Rotator cuff tendinopathy41.6%90.1%
    Active compression63 testLabral Pathology43% (0.31, 0.56)89% (0.67, 0.97)
    Yergason’s test61Biceps tendinopathy/labral pathology12.4% (6.60, 20.6)95.3% (90.6, 98.1)
    Speeds33Biceps tendinopathy75% (0.54-0.96)45% (0.37-0.52)
    Cross arm62AC Joint pathology26.9%88.4%
    Internal rotation lag test64Subscapularis tendon tear41%91%
    Apprehension/Relocation61Anterior Instability64.6%90.2%
    • Abbreviations: AC, Acromioclavicular; CI, Confidence interval.

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The Journal of the American Board of Family     Medicine: 37 (6)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 6
November-December 2024
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A Simplified Approach to Evaluate and Manage Shoulder Pain
Kartik Sidhar, Hyung Jin Lim, Laurel Gutierrez
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1156-1166; DOI: 10.3122/jabfm.2024.240114R2

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A Simplified Approach to Evaluate and Manage Shoulder Pain
Kartik Sidhar, Hyung Jin Lim, Laurel Gutierrez
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1156-1166; DOI: 10.3122/jabfm.2024.240114R2
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  • Article
    • Abstract
    • Introduction
    • History
    • Physical Examination
    • Terminology
    • Evaluating Shoulder Pain
    • Preserved Range of Motion
    • Loss of Active and Passive Range of Motion
    • Loss of Active Range of Motion, Preserved Passive Range of Motion
    • Less Common Causes of Shoulder Pain
    • Non-Musculoskeletal Causes of Shoulder Pain
    • Conclusion
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

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Keywords

  • Diagnostic Ultrasound
  • Physical Examination
  • Physical Therapy
  • Range of Motion
  • Rotator Cuff Injuries
  • Shoulder Pain
  • Sports Medicine

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