MSK - the shoulder Flashcards
What are some common arthrogenic, myogenic and neurogenic hypotheses?
Arthrogenic: - OA/RA - Adhesive capsulitis Myogenic: - Subacromial shoulder pain - Rotator cuff tear - Dislocation shoulder instability Neurogenic: - Cervical radiculopathy
Give the assessment of early and advanced OA
Early stage: - complain of mild pain - progressive, activity-related pain - pain described as deep Advanced stages: - loss of AROM and PROM - joint may appear enlarged and swollen
What management techniques are available for OA?
Educate and reassure Initial management - activity modification, rest and ice - strength training and aerobic exercise - pain relief Late stage - corticosteroid injection to help relieve pain & swelling - surgical options are available
What is adhesive capsulitis and what are its effects?
“frozen/stiff shoulder”
Limited AROM and PROM, especially ER
Thickening of the glenohumeral joint capsule leads to stiffness and dysfunction
Describe the progression of adhesive capsulitis and how long does it take to resolve?
Stage 1 (freezing phase) - complain of shoulder pain, especially at night - ROM is usually normal Stage 2 (freezing phase) - begin to develop stiffness - loss of ROM, especially IR and ER] - still painful Stage 3 (frozen phase) - profound loss of ROM - painful at extremities of movement Stage 4 (thawing phase) - persistent stiffness - minimal pain as synovitis has resolved - slow improvement in shoulder mobility
Usually a self-limiting disease that resolves in 1-3 years
Briefly describe what subacromial pain syndrome is, its symptoms, its cause, and aggravations
Non-traumatic, usually unilateral, shoulder problems that cause pain, localized around the acromion.
Often present with:
- painful arc of pain
- pain after activity and early AM
- pain during ER and elevation
Pain is usually associated with a change in load to the tendon and often worsens during overhead activities and overuse
Briefly describe what rotator cuff tendinopathy is, its symptoms, its cause, and aggravations
Indicates a problem with your shoulder muscles. It can be caused by an overload of the four muscles located in that region, or an inflammation of one of the tendons.
Often present with:
- painful arc of pain
- pain after activity and early AM
- pain during ER and elevation
Pain is usually associated with a change in load to the tendon and often worsens during overhead activities and overuse
What is massive inoperable rotator cuff tear, what is its mechanism, who does it affect and what are its symptoms?
Occurs in patients with RC degeneration and RC muscle failure (atrophy).
Trauma or insidious onset
Older person (over 60)
Massive loss of AROM, no loss of PROM
What would be included in a subjective history of the shoulder joint?
- Onset
- insidious/ trauma/ timescale - Pain behaviours
- location, severity, 24-hour pattern, aggs and eases - Special questions
- locking, red flags, previous dislocations - PMH and general health
- THREADS
How do glenohumeral joint related pains differ from acromioclavicular joint and sternoclavicular joint pain?
Glenohumeral joint pains = commonly felt over the anterior deltoid, often extending into the region of the distal deltoid and biceps
Acromioclavicular joint and sternoclavicular joint pain = often felt locally around the joint
What special questions could you ask for the shoulder joint?
- Have you experienced problems with this area before?
- Any locking or catching?
- Persistent loss of ROM
Give some red flags for the shoulder joint
- history of cancer
- sudden weight loss
- fracture
- dislocation
- history of heart attack
- sweating and chest pain when shoulder pain occurs
- jaw, mouth or teeth pain when shoulder hurts
What would you look for in both the informal and formal observation?
Informal - observe how they use their arms, facial expressions and quality of movement Formal - observe in sitting and standing - skin colour changes - inspect muscle bulk for symmetry - head of humerus - elbow length - compare epicondyles
How can you perform scapula wing testing, and if positive, what does this suggest?
In standing, patient flexes both arms to 90degrees and does a push up off the wall. If winging of medial border occurs = long/weak serratus anterior
What would you palpate during the objective assessment?
Temperature of area Swelling and deformity Bruising Mobility and feel of soft tissue Tenderness of bone Clavicular space
