Disorders of the Shoulder Flashcards
Shoulder Pain
3rd most common joint pain
When considering pain the shoulder extra-shoulder causes must be excluded and peri-articular and articular causes considered
Causes of pain referred to the shoulder
Cervical Spondylosis
Mediastinal pathology
Cardiac ischaemia
Non-shoulder pathologies to be excluded
Infection
Fracture
Tumours
Shoulder disorders
Extracapsular - Rotator Cuff pathologies
Intracapsular - joint instability, adhesive capsulitis, OA/RA
History of shoulder pain
Must identify - pain, stiffness/loss of movement, deformity, functional loss,
Examining shoulder pain
Must look (skin changes, scars, swelling), feel (temperature, creptitus, tenderness) and move (actively and passively)
Special tests for shoulder pain
Impingement tests (painful arc) Instability/apprehension tests
Shoulder problems in a young adult
Instability until proven otherwise - especially if they play lots of contact sports
Shoulder problems in a middle aged person
Rotator Cuff - impingement (tendinosis/tendinitis)
- Partial or complete RC tears
Adhesive capsulitis/Frozen shoulder
Shoulder problems in a old person
Rotator cuff disorders - impingement, tears or arthropathy
OA
Rotator Cuff impingement
The tendons of the RC become inflamed as they pass under the acromion - or are squeezed by bony spurs or swollen subacromial bursa
This causes pain, weakness and loss of movement with a painful arc from 60-120 degrees
Management of Rotator Cuff impingement
Conservative – analgesia/NSAIDs, LA, physiotherapy
Acromioplasty
Causes of RC impingement (4)
Inflammation of the tendons of the RC
Bony spurs from the Acromion
Swollen subacromial bursa
RC weakness allowing the humeral head to move superiorly
Investigations for shoulder disorders (5)
X-rays, USS, MRI, CT scans, Arthroscopy
Calcific tendinitis
The deposition of calcium crystals in muscle tendons particularly in the shoulder causing pain and inflammation
This can cause a ‘frozen shoulder’
Adhesive capsulitus (frozen shoulder)
A disorder of thickening, contracture & adhesion formation of the shoulder capsule causing pain and limited movement (external rotation most effected) - middle aged or women. initial severe pain with some stiffness, which then lessens and is replaced by more stiffness which eases over a number of years
AC joint problems
Most commonly affects males in their 20s
Most commonly traumatic joint disruption from contact sports or OA related
Will be severe pain and if separated there will be a visible ‘step’
Rotator Cuff Disorders
Present 35-75yrs, Tendon tears usually follows trauma in young people but can be atraumatic in the elderly
Partial tears are often hard to distinguish from tendonitis but complete tears may cause ‘shoulder drop’ when lowering past 90 degrees
Causes of Shoulder Instability
Can be traumatic, atraumatic or due to muscular problems
Repeated trauma will produce instability as will Rotator cuff or labrial tears
Treatments of Shoulder instability
Conservative if the problem is minor and the patient does not want to continue sports etc
Surgical - arthroscopic (Bankart repair) stabilization or if there is multidirectional instability can use a capsular shift
Management of Shoulder OA/RA
Management should be conservative and medical at first to limit disease progression –> if there is significant pain then joint replacement should be considered
Causes of adhesive capsulitis
Immobility or systemic diseases (diabetes)
Spontaneous or after shoulder surgery
Calcific tendinitis
Rockwood classification of ACJ disruption
I - Sprain without tear II - AC ligaments torn but CC not
III - Both sets of ligaments torn with >5mm elevation-+#
IV - Lateral clavicle separated and displaced posteriorly
V - Complete separation of the scapula and clavicle
VI - As with V but with inferior detachment of the clavicle
Management of ACJ dysfunction
Type I and II managed conservatively with sling for 1-3wks and physiotherapy - type III usually also managed like this
Type IV, V & VI should be treated with ORIF
