Table 1 lists the differential diagnostic considerations of shoulder pain. Table 2 offers some useful tips about fingernails.
It is uncertain whether this patient also had tendinitis: visceral conditions, including coronary artery disease can occasionally aggravate preexisting musculoskeletal conditions. Therefore, be wary of ending your diagnostic process prematurely when a second condition may be present. Chest films for this patient show a pulmonary mass at the right hilar area (Figure 2).
Table 1. Quick essentials on shoulder pain differential diagnosis
Anterior: Acromio-clavicular joint arthritis, glenohumeral joint arthritis, biceps tendinitis Posterior: Neck conditions, suprascapular nerve entrapment Lateral: Impingement, tendinitis, rotator cuff (all usually aggravated by reaching overhead) Other: Brachial plexus, vascular disease, thoracic outlet syndrome, lung tumor, myocardial infarction, abdominal aortic aneurysm, pericarditis, GI disease |
Table 2.Quick essentials on fingernail conditions
Fingernails: Made of keratin. Average growth rate: 3 mm/mo for fingers; 1 mm/mo for toes White lines: Muehrcke lines: low albumin; Mees lines: arsenic; nail base lines: paraneoplastic disease Fungus: Trichophyton rubrum infection in 90%. Risks: tight shoes, peripheral vascular disease, HIV infection, tobacco. Rx: terbinafine(Drug information on terbinafine) (≈ 45% relapse at 3 years) Clubbing: "CLUB": Congenital, Cardiac, Cirrhosis, Lung disease, Ulcerative colitis, Biliary disease Other: HIV infection, hyperthyroidism |
From Quick Essentials Emergency Medicine pocketbook, copyright EMresource.org
