LGS 2 Flashcards
What injuries are included in a SAPS (subacromial pain syndrome) diagnosis?
- Bursitis
- Tendinosis calcarean
- Supraspinatus tendinopathy
- Partial tear of the rotator cuff
- Biceps tendinitis
- Tendon cuff degeneration
SAPS is usually caused by a traumatic mechanism. True or False?
False.
It’s usually non-traumatic
Provide a brief overview of subacromial pain syndrome.
- Non-traumatic
- Usually unilateral
- Shoulder problems that cause pain, localized around the acromion
- Often worsening during or due to lifting of the arm
What are the rotator cuff muscles?
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
What is the percentage of adults that have shoulder pain?
(provide a range)
7-34%
Incidence: around 19/1,000 person-years
In what population (sex & age) are shoulder injuries highest?
- Females
- Over 45 years old
What are the most common shoulder injuries?
- Shoulder impingement syndrome
(Subacromial bursitis & Subacromial tendinitis) - Rotator cuff tears
- Biceps tendinitis
- Rupture of long head of biceps
What is the prevalence of rotator cuff tears by age groups?
- 9% of individuals <21 years
- 30-50% of individuals >60 years
- 62% of individuals 80+ years
What are the causes of rotator cuff injuries?
- Rotator cuff tears are the result of long-term degeneration and entrapment of the rotator cuff tendons as they pass between the head of the humerus and the acromion
- Sudden powerful elevation of the arm
- Fall onto the shoulder
Why don’t younger patients usually have rotator cuff/ tendon tears?
Younger patients: frequently result in avulsion of bone because their tendons are normal strength
What are some risk factors associated with SAPS?
- Repetitive movements of the shoulder or hand/wrist during work
- Work that requires much or prolonged strength of the upper arms
- Hand-arm vibration (high vibration and/or prolonged exposure) at work
- Working with a poor ergonomic shoulder posture
- High psychosocial workload
What are some psychological risk factors for prolonged SAPS?
- High psychological demands
- Low control
- Low social support
- Low job satisfaction
- High pressure to perform
What are some common differential diagnoses for soft tissue shoulder pain?
- C-spine injury (nerve root impingement, c-spine muscle strain)
- Elbow injury (joint sprain, muscle strain)
- Brachial plexus injury
- Shoulder fracture (humerus, clavicle)
*Remember to always look ABOVE and BELOW the suspected injury site!
What are some ways to diagnose rotator cuff using imaging? When should you do this?
- Ultrasound
- not as expensive and just as good at detecting full RC tears
- recommended after 6 weeks of symptoms - MRI
What are some ways to assess shoulder injuries in the clinic?
- ROM using goniometer
- Muscle strength testing
- Outcome measures (DASH, UEFI, Shoulder Disability Questionnaire)
What are some signs and symptoms of:
Rotator Cuff tendinitis, subacromial bursitis, rotator cuff tears, impingement syndromes
- Pain over proximal end of humerus
- Pain with active and/ or passive movements (depending on structure involved)
- Pain and limited movement/strength with shoulder abduction/ER most common
What are some signs & symptoms of:
Tenosynovitis, rupture of long head of biceps tendon
- Pain in anterior aspect of the shoulder, radiating to the elbow
- Worse pain with abduction and external rotation
- Tenderness over the biceps tendon in the bicipital groove
The natural course of SAPS is favourable. True or False?
False.
The course is unfavourable.
What percentage of patients still have some kind of restriction and/ or pain after 1 year of SAPS?
After 1 year, 1/3 patients still have some kind of restriction and / or pain
~70% are free of restriction and pain after 1 year
What is the natural progression of SAPS?
Tendinitis → degeneration (tendinosis) → Tears
What are the grades of muscle/ tendon strain? Provide a brief overview of each.
Grade 1: mild damage to individual muscle fibers
Grade 2: more extensive damage with more muscle fibers involved; muscle is not completely ruptured
Grade 3: complete rupture of muscle or tendon
A longer duration of shoulder pain typically leads to poorer outcomes. What is this duration? At what age does this typically occur?
> 3 months of shoulder pain leads to poorer outcomes
- Ages 45-54
What amount of time is considered “chronic” shoulder pain? What about “acute” shoulder pain?
Chronic: >3 months
Acute: <6 weeks
What are some psychological factors associated with the prognosis of shoulder pain? Provide a brief explanation.
- Emotional / mental health – disability and pain
- Lower emotional / mental health function is associated with greater pain or disability or lower physical functioning at initial evaluations - Patient expectation is associated with patient –reported outcomes after treatment
- Higher expectation of benefit, greater the perceived benefit after surgery
