- pain w/ overhead motion of superiolateral shoulder - decreased active ROM - weakness abduction (tears) - 1/5 ppl have no sx (dont look for it w MRI!)

- "impingment" pain but past elbow - WEAKness w/ overhead movmt - NL passive ROM - night pain - many 40+ have asym partial

1. XR - AP, axillary, outlet view 2. MRI

50% affected tendon: NSAID 50% affected tendon: prob surgery complete tear - surgery ASAP

MSK - UE and LE Flashcards by Kalin .

impingement syndrome (rotator cuff syndrome)

reduction in space below coracromial arch resulting in…

supra/infraspinatus tendons compressed under acromion
subacromial bursitis

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possible etiology of impingement

SITS weak -> deltoid hypertrophy -> humerus sup displaced

bone spur (age)
inflammation of coracromial joint

any/all

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tendonosis v tendonitis

damage v inflammation

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impingment complications

tendonitis
tendonosis
rotator cuff tear (weakness)

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impingment symptoms

pain w/ overhead motion of superiolateral shoulder
decreased active ROM
weakness abduction (tears)
1/5 ppl have no sx (dont look for it w MRI!)

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bursitis v tendonitis pain

burning and acute v intermittent + dull

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MC rotator cuff tear

supraspinatus

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2 tests for impingment

Neer, Hawkins

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imaging in shoulder pain

X-ray: arthritis, trauma, calcific tendonitis
MRI: bursistis, partial/full tear, tendonitis
US: r/o tears

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impingment tx

NSAID, rest, ice
lidocaine + methylprednisone <6 wk
PT: strengthen cuff, stretch
f/u 6 weeks - surgery if no improvement

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rot cuff tear etiology

chronic impingment syndrome
chronic dislocation
acute trauma

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rot cuff tear sx

“impingment” pain but past elbow
WEAKness w/ overhead movmt
NL passive ROM
night pain
many 40+ have asym partial

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3 tests for rot cuff

drop arm (all)
empty can (supraspinatus)
lift off (subscapularis)
external rot elbow (infraspin, teres minors)
ext rot lag (infraspin)

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rot cuff imaging

XR - AP, axillary, outlet view

2. MRI

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fatty atrophy prognosis

means chronic tear, unlikely for good surgery outcome

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rot cuff tx

<50% affected tendon: NSAID< steriod injection, PT
>50% affected tendon: prob surgery
complete tear - surgery ASAP

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post surg recover time (rot cuff tear)

12 weeks “normal”

6-12mo “total function” athletes

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biceps tendonitis: primary v 2ndary

1 - just occurs in this tendon

2- impingement syndrome 1st

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biceps tendonitis sx

anterior shoulder pain- rad to bicep
tenderness over bicepital groove
+Neer, Hawkins

tests for biceps tendonitis besides Neer and Hawkin

Speed - arm @ shoulder level, bend elbow against resistance

Yergason - pressure over biceptal groove, arm bent, bend elbow against ext rot

biceps tendonitis imaging

shoulder xray (impingment)

- MRI (edema around thickened tendon)

biceps tendonitis tx

NSAID, PT, ice
US-guided steroid injections
surgery if conservative fails (cut labrum and re-attach)

adhesive capsulitis - primary v 2ndary

AI, females, DM

2. postsurg, post trauma post immobilization

adhesive capulitis - sx

gradual loss of active + PASSIVE ROM
worse @ end of motion
pain @ rest, @ night
STABILIZE SCAP during PE (masks tests)

adhesive capsulitis pathophys

soft tissue contracture | local inflam response

adhesive capsulitis tx

PT! ice, NSAID, steroid injection

glenohumeral OA sx

constant pain, worse w/ activity gradual onset crepitus

AC joint OA tx

mostly just steroid injections

OA tx

ROM NSAID no steroids (delays labral healing) surgery- arthoplasty

lateral epicondylitis (tennis elbow)

repetitive strain wrist extension (backhand stroke)

lateral epicondylitis (tennis elbow) sx

lateral elbow pain, radiating to forearm after activities pain after shaking hands weakened grip ROM intact

lateral epicondylitis tests

Cozens + Mills

lateral epicondylitis diagnosis + tx

H+P | conservative, steroid, US (magnetic relief), surgery not superior to conservative

medial epicondylitis "golfers elbow"

pain over medial epicondyle rad down | pain w/ wrist flexion

medial epicondylitis

conservative, splinting, inj 2x activity modification 1 mo surgery - release flexor elbow

olcranon bursitis etiology

trauma -> boggy swelling | not painful unless infected

olcranon bursitis dx

imaging: r/o fracture aspiration: if ? infection

olcranon bursitis tx

conservative, splint, compress swelling aspiration for pain relief but recur until fully healed surgery after 12 wk failed conservative (remove bursa)

de quervain "mommy thumb" muscle

abductor pollicis longus and extensor pollicis brevis overuse --> lateral wrist pain

de quervain tests

Finkelsteins

de quervain tx

conservative, thumb spica splint, injections | surgery: decompress tendon

depuytren contracture

fibroproliferative dz of palama fascia - genetics, men, N. Euro - smoking/EtOH (lots), DM - rep vibration

depuytren presentation

painless nodule @ MCP joint in 1+ fingers, expands to form "cord" over tendon, finger is stuck flexed

depuytren tx

gloves, fasciotomy if contracture has formed tx = palliative if untreated - disability in 5-6y

depuytren dx

H & P, no role for imaging