Common Causes of Shoulder Pain Flashcards
What are the 3 causes of tendonitis in the shoulder
- Degenerative
- Traumatic
- Calcific
What is the mc cause of shoulder pain (90%) of non traumatic painful disabilities
Tendonitis
What is the moi of injury for degenerative tendonitis, age, progression
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
What factors increase the risk of degenerative tendonitis
- Rounded shoulders depress gelnoid fossa (compress acromial arch)
- bony configuration (a sloped acromion will lead to increased incidence of impingment)
What is the moi for injury for traumatic tenonitis, age, symptoms
age- younger (20-40)
moi- studden load is taken by shoulder (pulling distally on head)
symp- Pain on selected resisted movements
pathology of calcific tendonitis
degeneration of tendon (on coracoacromial lig)
-result is calcium salts in highly vascular area, can buldge out and calcific mass can rupture tendon
What can acute sub acromial bursitis be due to (2)`+ symptoms
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
Tx of sub acromial bursitis
Rest, ice, IFC- 50% improve over 48hrs
total resolution in 1-2 weeks
What generally causes inpingment syndrome and where is pain usually felt
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
What is the cause of primary shoulder impingment
Mechanical obstruction of rotator cuff due to acromion inf aspect morphology
What is the cause of secondary shoulder impingement
Relative decrease in sub acromial space secondary to glenohumeral instability (disruption of static stabalizers/fatigue in dynamic stabailzers)
What are the general predisposing factors to shoulder impingement
- acromial morphology
- decrease in sub acromial space (due to bony config/swelling)
- Decrease vascular supply to rot cuffs
What symptoms will people with shoulder impingement present w (4)
Hx of chronic pain w overhead
Pain in ant shoulder
increased pain at night
Point tenderness within space between AC jt and coracoid process
tx and rehab of shoulder impingement
Apply ice/modalities for inflammation
Gradually restore ROM/strength
Adress posible saca stability’s and shoulder pec/flexability
Rotator cuff tear- age, location of pain/type, what tendon mc
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
Diagnosis of rotator cuff tear
Active ROM may be difficult (abduction)
-eccentric more painful than concentric
=PAIN + WEAKNESS
Therapy and rehab of rotator cuff tear
-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
Partial thickness tear vs full thickness tear
Partial- manifested by pain/weakness on resisted contraction (more painful)
Full- mc in adults 60+ (can be fully asymptomatic tho)
What are 90% of ant dislocations due to
due to anatomic weakness in the ant capsule
What are the 4 types of dislocations (+mc variant)
- Subcoaracoid (mc)
- Subclavicular
- Subglenoid
- Subspinous (post)
(1-3 mc)
moi of dislocation (ant + post)
Most are abduction/ext rot
Ant- mc falling on outstretched arm
Post- trauma (blow to front of shoulder)
what structural things give away in shoulder dislocations (in younger and older)
younger- ant glenoid lig gives (tear in ant capsule)
older- Rotator cuff tears (ant capsule just stretches)
Would should be strengthened in an shoulder dislocation
- Shouldnt be left in sling (early movement)
- Strengthen int rotators, adductors (deemphasize ext rot)
Ant vs post dislocation presentation
ant- lower end of humerus sticks out, may be abducted
post- coracoid is prominent, humerus is under spine of scapulas, fully int rot
What are the 2 methods to relocate an ant dislocation
Original hippocratic method
Kocher method
What are the 2 complications to look for after relocating a shoulder
- lack of blood flow (emergency(
2. Neuro symptoms (post cord usually affected)
Rehab for ant dislocations
Active exercises to strengthen adductors, int rot, abduction in int rot
Rehab for post dislocations
Active exercises in 3 w
-stress external abduction exercises
