Common Causes of Shoulder Pain

Question 1

What are the 3 causes of tendonitis in the shoulder

Answer 1

1. Degenerative
2. Traumatic
3. Calcific

Question 2

What is the mc cause of shoulder pain (90%) of non traumatic painful disabilities

Answer 2

Tendonitis

Question 3

What is the moi of injury for degenerative tendonitis, age, progression

Answer 3

moi- overhead work

age- 5th decade

progression-
~Sustatined ischemia of rotator cuff bw greater tub and acromion (in critical zone)
~ can start to wear away tuberosities
~ Sub acromial bursa thickens, invasion of calcium

Question 4

What factors increase the risk of degenerative tendonitis

Answer 4

• Rounded shoulders depress gelnoid fossa (compress acromial arch)
• bony configuration (a sloped acromion will lead to increased incidence of impingment)

Question 5

What is the moi for injury for traumatic tenonitis, age, symptoms

Answer 5

age- younger (20-40)

moi- studden load is taken by shoulder (pulling distally on head)

symp- Pain on selected resisted movements

Question 6

pathology of calcific tendonitis

Answer 6

degeneration of tendon (on coracoacromial lig)

-result is calcium salts in highly vascular area, can buldge out and calcific mass can rupture tendon

Question 7

What can acute sub acromial bursitis be due to (2)`+ symptoms

Answer 7

1) vigorous activity on untrained or unprepared mm
2) sudden pull down on arm

All movements are very restricted + painful
pt holds arm @ side as if were slinged

Question 8

Tx of sub acromial bursitis

Answer 8

Rest, ice, IFC- 50% improve over 48hrs

total resolution in 1-2 weeks

Question 9

What generally causes inpingment syndrome and where is pain usually felt

Answer 9

impinge of tendons of rotator cuff, sub acrom bursa, long head of biceps under coracoacromial arch (rep overhead activities, weak ext rot)

-pain is diffuse and seen usually in ant portion of shoulder

Question 10

What is the cause of primary shoulder impingment

Answer 10

Mechanical obstruction of rotator cuff due to acromion inf aspect morphology

Question 11

What is the cause of secondary shoulder impingement

Answer 11

Relative decrease in sub acromial space secondary to glenohumeral instability (disruption of static stabalizers/fatigue in dynamic stabailzers)

Question 12

What are the general predisposing factors to shoulder impingement

Answer 12

1. acromial morphology
2. decrease in sub acromial space (due to bony config/swelling)
3. Decrease vascular supply to rot cuffs

Question 13

What symptoms will people with shoulder impingement present w (4)

Answer 13

Hx of chronic pain w overhead
Pain in ant shoulder
increased pain at night
Point tenderness within space between AC jt and coracoid process

Question 14

tx and rehab of shoulder impingement

Answer 14

Apply ice/modalities for inflammation
Gradually restore ROM/strength
Adress posible saca stability’s and shoulder pec/flexability

Question 15

Rotator cuff tear- age, location of pain/type, what tendon mc

Answer 15

Usually seen in pts. 50+ (overhead work)
Pain in ant port of rotator cuff
pain will have pain immediately then may have period w no pain then pain returns

Question 16

Diagnosis of rotator cuff tear

Answer 16

Active ROM may be difficult (abduction)
-eccentric more painful than concentric

=PAIN + WEAKNESS

Question 17

Therapy and rehab of rotator cuff tear

Answer 17

-Ice and IFC to reduce swelling/ laser

**restore strength of rotator cuff muscles injured by retraining contraction away from pain and insisting on eccentric contraction

Question 18

Partial thickness tear vs full thickness tear

Answer 18

Partial- manifested by pain/weakness on resisted contraction (more painful)

Full- mc in adults 60+ (can be fully asymptomatic tho)

Question 19

What are 90% of ant dislocations due to

Answer 19

due to anatomic weakness in the ant capsule

Question 20

What are the 4 types of dislocations (+mc variant)

Answer 20

1. Subcoaracoid (mc)
2. Subclavicular
3. Subglenoid
4. Subspinous (post)

(1-3 mc)

Question 21

moi of dislocation (ant + post)

Answer 21

Most are abduction/ext rot

Ant- mc falling on outstretched arm

Post- trauma (blow to front of shoulder)

Question 22

what structural things give away in shoulder dislocations (in younger and older)

Answer 22

younger- ant glenoid lig gives (tear in ant capsule)

older- Rotator cuff tears (ant capsule just stretches)

Question 23

Would should be strengthened in an shoulder dislocation

Answer 23

• Shouldnt be left in sling (early movement)

- Strengthen int rotators, adductors (deemphasize ext rot)

Question 24

Ant vs post dislocation presentation

Answer 24

ant- lower end of humerus sticks out, may be abducted

post- coracoid is prominent, humerus is under spine of scapulas, fully int rot

Question 25

What are the 2 methods to relocate an ant dislocation

Answer 25

Original hippocratic method

Kocher method

Question 26

What are the 2 complications to look for after relocating a shoulder

Answer 26

1. lack of blood flow (emergency(

2. Neuro symptoms (post cord usually affected)

Question 27

Rehab for ant dislocations

Answer 27

Active exercises to strengthen adductors, int rot, abduction in int rot

Question 28

Rehab for post dislocations

Answer 28

Active exercises in 3 w

-stress external abduction exercises