Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Regional limb pain

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Orthopaedics, Rheumatology
Progress Test Topic(s)
A 53 year old NZ European female presents with pain in her right shoulder that is worse with movement and restricts her range of motion. She states the pain has been present for the past 6 months and has developed gradually. It has become worse this week after she had a minor fall. The pain is now affecting her occupation as a bartender and causing her to have multiple days off work.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the shoulder and the rotator cuff muscles
   - Physiology of pain pathways
   - Physiology of muscle contraction
   - Pathophysiology of osteoarthritis
   - Soft tissue musculoskeletal pain
Clinical and Communication Skills 
   - History from a patient with regional limb pain
   - Examination of the shoulder including test of rotator cuff and acromio-clavicular joint; include neck examination and neurovascular assessment
   - Differential diagnosis of shoulder pain
   - Interpretation of plain X-rays of the shoulder and clavicle
   - Indications for plain X-ray, ultrasound scan and MRI
   - Indications and contraindications for local anaesthetic or steroid injection
   - Role of physiotherapy, rehabilitation and orthopaedic surgery
Personal and Professional Skills 
   - ACC funding for injuries and how this might impact a patient's history
   - Injuries that have significant implications on work and social functioning
Population Health 
   - Epidemiology of falls and strategies of preventing falls
Conditions to be considered relating to this scenario
rotator cuff disorders, frozen shoulder (adhesive capsulitis), acromioclavicular joint problems, shoulder instability, clavicle fracture/nonunion, pain syndrome
Less common but 'important not to miss'
bony metastases, posterior sternoclavicular joint dislocation, referred abdominal pain, referred cardiac pain, brachial neuritis
osteoarthritis, gout, thoracic spine pathology