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CP3 @ UoN - Musculoskeletal & MDD > Regional Peri-Articular Pain - Shoulder > Flashcards

Regional Peri-Articular Pain - Shoulder Flashcards

1
Q

What are the common differentials for shoulder pain?

A 
Acute (calcific) rotator cuff tendonitis
Chronic rotator cuff tendonitis
Rotator cuff tear
Adhesive capsulitis
Subacromial bursitis
Cuff arthropathy
Osteoarthritis
Rheumatoid arthritis
Polymyalgia rheumatica
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2
Q

How does articular pathology present?

A

Global sx affecting all movements

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3
Q

What are the two main types of articular pathology?

A

Inflammatory
-morning stiffness easing on movement
Degenerative
-worse after repeated use

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4
Q

What are the peri-articular causes of shoulder pain?

A 
Acute (calcific) rotator cuff tendonitis
Chronic rotator cuff tendonitis
Rotator cuff tear
Adhesive capsulitis
Subacromial bursitis
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5
Q

What is Acute (calcific) Rotator Cuff Tendonitis?

A

Deposition of apatite in supraspinatus tendon, leading to intense inflammation/swelling

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6
Q

How does Acute (calcific) Rotator Cuff Tendonitis present?

A 
Young patients
Aching pain following overuse
   -pain increases to climax, then resolves over few days
Arm held immobile
   -joint too tender to touch
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7
Q

What investigation may be appropriate in Acute (calcific) Rotator Cuff Tendonitis?

A

X-ray (calcification above greater tuberosity)

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8
Q

What is the management of Acute (calcific) Rotator Cuff Tendonitis?

A

Resting arm in sling
NSAIDs
Intra-capsular corticosteroid/lignocaine injections

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9
Q

How long does Acute (calcific) Rotator Cuff Tendonitis take to resolve?

A

1-3wks

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10
Q

What is Chronic Rotator Cuff Tendonitis?

A

Subacute/chronic vascular response causing pain/stiffness

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11
Q

What causes Chronic Rotator Cuff Tendonitis?

A

Overuse/minor tears of rotator cuff causing subacute/chronic vascular response

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12
Q

How does Chronic Rotator Cuff Tendonitis present?

A 
Pain in shoulder
   -worse at night
   -worse when abducting/elevating arm
Tenderness below anterior edge of acromion
Painful arc (60-120o) present
Power normal
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13
Q

What investigation may be appropriate in Chronic Rotator Cuff Tendonitis?

A

X-ray (calcification from former events)

USS/MRI (diagnostic)

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14
Q

What is the management of Chronic Rotator Cuff Tendonitis?

A

NSAIDs
Corticosteroid injection
Physiotherapy
Arthroscopic decompression of rotator cuff
-excision of coraco-acromial ligament & osteophytes

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15
Q

What causes Rotator Cuff Tears?

A

Trauma (younger pts)

Spontaneously (elderly pts)

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16
Q

What are the two main types of Rotator Cuff Tear?

A 
Partial
   -frequently occur w/ (may precipitate) chronic tendonitis
   -can repair naturally
Complete
   -will not repair naturally
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17
Q

How do Rotator Cuff Tears present?

A

‘Sprain’ of shoulder, limited abduction after event

18
Q

What are the signs on examination of Rotator Cuff Tears?

A

Tenderness over ant acromium

Abduction paradox

19
Q

What is the abduction paradox?

A

Once arm has been lifted above shoulder it can be held there by deltoid
When pt lowers arm it suddenly drops

20
Q

How can partial/complete Rotator Cuff Tears be distinguished?

A

Intra-articular anaesthetic injection

-partial tears regain abduction movement when pain abolished

21
Q

What investigations may be appropriate in Rotator Cuff Tears?

A

USS/MRI/arthroscopy (confirm diagnosis)

22
Q

How is the acute phase of a Rotator Cuff Tear managed?

A

Heat
Exercises
Local anaesthetic injections

23
Q

When can the extent of a Rotator Cuff Tear be assessed?

A

3 weeks

24
Q

How are Complete Rotator Cuff Tears managed?

A

Surgically repaired in younger individuals

25
Q

How are Partial Rotator Cuff Tears managed?

A

Conservatively treated to allow natural healing

26
Q

What is Adhesive Capsulitis?

A

Also known as frozen shoulder, more common diabetes

27
Q

How does Adhesive Capsulitis present?

A 
Initial progressive 'deep' pain
   -stops pt sleeping on affected side
   -subsides after few mo
Increasing stiffness
   -worsens as pain subsides
   -lasts 6-12 mo
Resolves spontaneously after 18mo
28
Q

What are the signs on examination of Adhesive Capsulitis?

A

Limited signs, joint cannot be moved due to pain

Limited external rotation

29
Q

How is Adhesive Capsulitis managed?

A

Reassurance
NSAIDs
Intra-articular steroid injections

30
Q

What is Subacromial Bursitis?

A

Inflammation of the bursa below the acromion

31
Q

What causes Suabcromial Bursitis?

A

Repetitive overhead lifting/pulling

Trauma

32
Q

How does Subacromial Bursitis present?

A

Burning pain

  • worse when lifting above head
  • stiffness when passively abducting arm
33
Q

What investigations may be appropriate in Subacromial Bursitis?

A

USS/MRI (to distinguish from cuff pathology)

34
Q

What is the management of Subacromial Bursitis?

A

NSAIDs

Avoid exacerbating movements

35
Q

What is a Rotator Cuff Syndrome?

A

Any peri-atricular pathology until diagnosis has been confirmed radiologically

36
Q

What are the potential complications of rotator cuff pathology?

A

Subluxation of humeral head

Cuff arthropathy

37
Q

What is Painful Arc/Impingement Syndrome?

A

Painful arc from 80-120o

  • due to swelling/oedema
  • decreases space b/w humeral head & acromion
38
Q

How can Impingement Syndrome due to articular/peri-articular pathology be distinguished?

A

Articular
-painful on both active/passive movements
Peri-articular
-less painful on passive movements

39
Q

What is the classic presentation of ACJ OA?

A

Painful high arc
Crepitus
Global pain/stiffness
Scarf test +ve

40
Q

What is the Scarf Test?

A

Passive adduction across body horizontally causing pain

CP3 @ UoN - Musculoskeletal & MDD (26 decks)

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