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Rotator cuff tear
Shoulder & Clavicle
AC separation
Biceps tendon rupture
Clavicle fracture
Humerus proximal fracture
Rotator cuff tear
Scapular fractures
Shoulder dislocations
SLAP tear
Sternoclavicular dislocation
Arm & Elbow
Compartment syndrome (anterior, lateral, deep - superficial posterior)
Coronoid process fracture
Elbow dislocations
Epicondylar fracture
Humeral shaft fracture
Intercondylar and condylar region fracture
Olecranon fracture
Radial head fracture (Mason I-IV)
Supracondylar fracture (pediatric and adult)
Triceps tendon rupture
Forearm, Wrist & Hand
Carpal bones fractures
Carpal dislocations and ligament injuries
Distal radius and ulna fracture
Fight bite (human bite over MCP)
Finger dislocations by joint
Finger open fractures - amputations
Forearm fractures
Hand and finger tendon and ligament injuries
Hand tendon injuries
Metacarpal fractures
Nail bed injuries
Phalangeal fractures
Tuft fracture
Spine
Cervical spine fracture (C1-C7)
Cord syndromes
Sacrum and coccyx fracture
Thoracic and lumbar spine fracture
Pelvis & Hip
Acetabular fractures
Hip dislocations
Pelvis fractures
Proximal femur fractures
Thigh & Knee
Distal femur fractures
Femoral shaft fractures
Knee dislocation
Knee ligament injuries
Patellar dislocation
Patellar fracture
Patellar tendon rupture
Pes anserine bursitis
Prepatellar bursitis
Quadriceps tendon rupture
Tibial plateau fracture
Tibial spine fracture
Tibial tubercle fracture
Leg & Shin
Achilles tendon rupture
Fibular shaft fracture
Proximal fibula fracture
Stress fracture (tibia-fibula)
Tibial and Fibular shaft fracture
Tibial shaft fracture
Toddler's fracture
Ankle
Ankle dislocation
Ankle fractures
Ankle sprain
Maisonneuve fracture (proximal fibula and syndesmosis)
Peroneal tendon dislocation or tear
Peroneal tendon tear or dislocation
Subtalar dislocation
Syndesmotic injury (high ankle sprain)
Foot
Calcaneus fracture
Cuboid fracture
Cuneiform fractures
Dancer's fracture (5th MT spiral shaft)
Jones fracture (5th MT base - metadiaphyseal junction)
Lisfranc injury (tarsometatarsal dislocation)
March fracture (metatarsal stress fracture)
Metatarsal fractures (1st-5th)
Navicular fracture
Plantar fascia rupture
Talus fracture
Tibialis posterior tendon dysfunction
Toe dislocations
Rotator cuff tear
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Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
Approach to the Critical Patient
Triage and limb threat
Triage priorities
▶
Concurrent shoulder dislocation concern
▶
Immediate reduction pathway if confirmed
Open injury over shoulder concern
▶
Open fracture pathway and antibiotics
Neurovascular compromise
▶
Axillary nerve sensory loss over lateral deltoid
Distal pulses and capillary refill
Immediate imaging and escalation
Time critical diagnostics
▶
Shoulder radiographs before reduction attempt if stable
▶
AP view
Scapular Y view
Post reduction radiographs if dislocation reduced
▶
AP view
Axillary view if tolerated
Analgesia safety and monitoring
Pain control and sedation readiness
▶
Non opioid analgesia first line when possible
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Acetaminophen and NSAID if no contraindication
Opioid titration if severe pain
▶
Reassessment after each dose
Procedural sedation pathway if reduction required
▶
Capnography use reduces adverse respiratory events ACEP Level B
Key decision points
Early red flags that change pathway
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Pseudoparalysis after trauma
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Urgent shoulder specialist referral for suspected acute full thickness tear
Older patient after traumatic anterior dislocation
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High prevalence of associated cuff tear and early imaging recommended
History
Mechanism and timeline
Injury context
▶
Acute traumatic mechanism
▶
Fall on outstretched hand
Direct blow or traction injury
Time since injury
▶
Time since any reduction attempt
Prior shoulder instability
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Prior dislocations or subluxations
Symptom pattern and function
Functional impact
▶
Immediate weakness and inability to abduct
▶
Pseudoparalysis definition inability to actively elevate despite passive range preserved
Night pain
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Sleep disruption
Mechanical symptoms
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Clicking or catching
Risk modifiers
Baseline risks
▶
Age over 40 years
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Increased probability of cuff tear after traumatic dislocation
Anticoagulant use
▶
Expanding hematoma concern
Prior rotator cuff disease
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Prior imaging or injections
Physical Exam
Inspection and palpation
Shoulder overview
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Deformity consistent with dislocation
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Loss of deltoid contour
Ecchymosis and swelling
▶
Proximal arm hematoma
Greater tuberosity tenderness
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Occult fracture concern
Range of motion and strength
Rotator cuff focused findings
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Active abduction limitation
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Pseudoparalysis
External rotation weakness
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Infraspinatus involvement
Positive drop arm sign
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Suggests full thickness supraspinatus tear
Neurovascular
Neurovascular exam
▶
Axillary nerve function
▶
Deltoid contraction
Sensation over lateral deltoid
Distal motor and sensory
▶
Radial median ulnar screening
Perfusion
▶
Radial pulse and capillary refill
PITFALLS
Common misses
▶
Missed cuff tear after dislocation in older patient
▶
Weakness reassessment after pain control and reduction
Overcalling tear when pain inhibits effort
▶
Repeat strength testing after analgesia
Differential Diagnosis
Shoulder trauma differentials
Alternative diagnoses
▶
Anterior glenohumeral dislocation ICD-10 S43.01
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Rotator cuff tear as associated injury
Proximal humerus fracture ICD-10 S42.2
▶
Greater tuberosity fracture mimic
Acromioclavicular separation ICD-10 S43.1
▶
Pain localized to AC joint
Neurologic and tendon mimics
Mimics of weakness
▶
Axillary nerve neuropraxia ICD-10 S44.3
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Sensory loss over lateral deltoid
Cervical radiculopathy ICD-10 M54.12
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Neck pain or dermatomal symptoms
Biceps tendon rupture ICD-10 S46.1
▶
Popeye deformity
Non traumatic differentials
Atraumatic considerations
▶
Calcific tendinitis ICD-10 M75.3
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Acute severe pain without trauma
Septic arthritis ICD-10 M00.9
▶
Fever and severe pain with minimal motion
Laboratory Tests
Labs when uncomplicated isolated tear
Usually not indicated
▶
No routine labs for isolated suspected cuff tear
Pain control and imaging focused pathway
Labs when infection or systemic illness concern
Infection screen
▶
White blood cell count for septic arthritis concern
▶
Limited sensitivity early disease
CRP for inflammatory or septic concern
▶
Trend value over single value
Blood cultures if febrile and septic concern
▶
Before antibiotics if feasible
Labs for procedural sedation or operative pathway
Sedation and surgery readiness
▶
Glucose for diabetes or altered mental status
▶
Hypoglycemia exclusion
Pregnancy test when applicable
▶
Imaging and medication selection implications
INR and platelet count if anticoagulants or bleeding risk
▶
Hematoma and procedural risk
Diagnostic Tests
Scoring Systems
Functional and severity tools
▶
ASES score for baseline function tracking
▶
Use in follow up and rehab response
Constant Murley score for outcome tracking
▶
Use in specialist clinics
Pain and function documentation anchors
▶
Active forward elevation degrees
External rotation strength grade
Radiographs
X ray indications and views
▶
Trauma series
▶
AP shoulder
Scapular Y
Axillary view if tolerated
Dislocation and fracture exclusion
▶
Greater tuberosity avulsion
Hill Sachs and bony Bankart if dislocation
Normal X ray does not exclude cuff tear
▶
Proceed to ultrasound or MRI if high suspicion
MRI
MRI role
▶
Full thickness tear confirmation and retraction assessment
▶
Surgical planning value
Pseudoparalysis after trauma
▶
Urgent imaging pathway
MRI performance high for full thickness tears per ACR evidence based criteria
▶
Use when ultrasound expertise limited
CT
CT role
▶
Occult fracture suspicion despite negative X ray
▶
Greater tuberosity or glenoid fracture
Preoperative bony anatomy when fracture dislocation pattern
▶
Surgical planning support
Not first line for isolated soft tissue tear
▶
Prefer ultrasound or MRI per ACR criteria
Disposition
Discharge vs urgent referral
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Disposition framework
▶
Discharge with expedited outpatient imaging and follow up
▶
Preserved active elevation
Pain controlled with oral meds
Urgent shoulder specialist referral
▶
Suspected acute full thickness tear after trauma
Pseudoparalysis
ED ortho consultation or transfer
▶
Associated dislocation not reducible
Neurovascular deficit not resolving
Follow up timing
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Follow up targets
▶
Suspected acute traumatic tear
▶
Specialist evaluation ideally next available clinic per BESS BOA pathway statement
Post dislocation with weakness in older patient
▶
Early ultrasound or MRI recommended by BESS BOA pathway
Physical therapy initiation window
▶
After fracture and dislocation excluded and pain controlled
Treatment
Symptom control and definitive care
Nonoperative initial care
▶
Relative rest and activity modification
▶
Avoid overhead lifting
Early range of motion as tolerated
▶
Prevent stiffness risk
Physical therapy
▶
Scapular stabilizers and rotator cuff strengthening progression
Surgical pathway triggers
▶
Acute traumatic full thickness tear with functional deficit
▶
Early surgical consultation supported in specialty pathways
Massive tear with pseudoparalysis
▶
Time sensitive repair consideration
Special Populations
Pregnancy
Pregnancy considerations
▶
Imaging selection
▶
Ultrasound preferred when feasible
MRI without gadolinium preferred if advanced imaging needed
Analgesia choices
▶
Acetaminophen preferred
NSAID avoidance in later pregnancy per obstetric guidance
Geriatric
Older adult considerations
▶
Higher likelihood of cuff tear after dislocation
▶
Weakness reassessment after reduction and analgesia
Higher stiffness risk
▶
Earlier mobilization and PT emphasis
Polypharmacy and delirium risk with opioids
▶
Lowest effective dose strategy
Pediatrics
Pediatric considerations
▶
Traumatic cuff tear uncommon
▶
Consider physeal injury and avulsion fractures
Imaging priorities
▶
Radiographs to exclude fracture and physeal injury
Referral triggers
▶
Persistent weakness or suspected avulsion requires specialist evaluation
Background
Epidemiology
Frequency and risk patterns
▶
Rotator cuff tear common cause of shoulder pain
▶
Incidence increases with age
Traumatic anterior dislocation association
▶
Meaningful proportion of patients over 40 years have associated cuff tear per BESS BOA pathway
Acute traumatic tears often full thickness
▶
Higher surgical consideration than degenerative tears
Pathophysiology
Injury mechanism
▶
Tendon failure under eccentric load
▶
Supraspinatus most commonly involved
Tear morphology
▶
Full thickness vs partial thickness
Retraction and muscle atrophy affect reparability
Pain and weakness drivers
▶
Loss of force couple and humeral head centering
Therapeutic Considerations
Treatment rationale
▶
Early identification of acute traumatic full thickness tear
▶
Potentially better repair biology than chronic tears per AAOS guidance context
Imaging selection
▶
Ultrasound effective with expertise
MRI for tear size and retraction per ACR criteria
Corticosteroid injection timing
▶
Short term pain relief option in selected cases with specialist guidance
Rehabilitation emphasis
▶
Stiffness prevention and scapular mechanics
Patient Discharge Instructions
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Discharge instructions
▶
Sling use for comfort
▶
Remove several times daily for gentle elbow wrist hand motion
Activity restrictions
▶
No heavy lifting
Avoid overhead reaching until cleared
Pain control plan
▶
Acetaminophen as directed
NSAID as directed if safe
Ice and elevation
▶
Ice 15 to 20 minutes at a time
Sleep with shoulder supported
Follow up plan
▶
Shoulder specialist or sports medicine within 1 to 2 weeks for suspected traumatic tear
Earlier follow up if severe weakness or pseudoparalysis
Return to ED now
▶
New numbness over lateral shoulder
Hand becomes cold pale or weak
Worsening pain not controlled with meds
Fever or redness if any wound
New visible deformity suggesting dislocation
References
Guidelines and key sources
Evidence sources
▶
AAOS Clinical Practice Guideline Management of Rotator Cuff Injuries 2025 update
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AAOS press release summary of updated guideline Aug 28 2025
AAOS Clinical Practice Guideline Management of Rotator Cuff Injuries 2019
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Prior guideline baseline for management recommendations
ACR Appropriateness Criteria Acute Shoulder Pain 2025
▶
Evidence based imaging selection for acute shoulder pain and suspected cuff tear
BESS BOA Patient Care Pathways Traumatic anterior shoulder instability 2015
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Urgent referral recommendation for acute traumatic rotator cuff tear
ACEP Clinical Policy Procedural Sedation and Analgesia in the Emergency Department 2014
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Capnography recommendation Level B
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SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Rotator cuff tear