Shoulder

Question 1

Tendonitis

Answer 1

=inflammation of rotator cup/ biceps tendon
Caused by tendon being pinched by surrounding structured E.g. acromion
Common in 25-40 YOA
Risks- old age, certain occupations, certain sports, genetic component
Symptoms- inability to hold arm in certain positions, pain/ tenderness in shoulder, pain at night
Prognosis- should go away on own. Treatments to reduce pain and preserve mobility, RICE, NSAIDs, physical therapy, cortisone Injection

Question 2

Bursitis

Answer 2

=inflammation of bursa caused by too much stress on bursa
Can be chronic (repetitive injury), infection or traumatic (repetitive rubbing of extremity against hard surface)
Common 40-65
Risks- old age, repetitive movements at work or hobbies, other medical conditions (e.g. RA)
Symptoms- pain, redness/ swelling, infected (warmth, nausea, radiating pain) traumatic (bruising)
Prognosis- will disappear after several weeks. NSAIDs, immobilisation, icing, steroid injections

Question 3

Subacrimial impingement

Answer 3

=shoulder tendon runs on nearby structures when arm flexes
Caused by overuse of tendon (torn/ swollen), irritated bursa or acromion disorders (not flat or bony spurs)
Occurs over 40 YOA
Risks- smoking, sleeping position, acromion shape, occupation
Symptoms- pain in top/ outer side of shoulder, pain that’s worse when arm is flexed and lifted above head, pain/ aching at night, weakness in arm
Prognosis- will improve in a few weeks/ months. Ice, pain relief, physical therapy and activity alteration can help

Question 4

Calcific tendonitis

Answer 4

=build up of calcium in rotator cuff tendons
Caused by wear and tear of tendons
Most common is supraspinatus tendon
Affects 40-60 YOA
Risks- tendon damage, lack of oxygen to tendons, genetics, abnormal thyroid gland activity, abnormal cell growth, metabolic diseases
Symptoms- pain on top of shoulder radiating down arm, worse when lifting arm away from shoulder, inflammation of bursa, sleep disruption
Prognosis- normally goes on own. Treatments can help it getting worse, anti inflammatory injections, surgery, shockwave treatment

Question 5

A/C joint arthritis

Answer 5

=chronic inflammation of joint
Usually osteoarthritis, but may be inflammatory conditions, septic arthritis or injuries
Over 50’s
Risks- history of shoulder joint instability or traumatic injury, repetitive trauma from sport, having a form of arthritis
Symptoms- pain when sleeping on that side, loss ROM in shoulder, more pain when shoulder is compressed, visible inflammation and increased prominence around joint
Prognosis- can be managed but not reversed. NSAIDs, physical therapy, steroid injections, isolated ac joint resection

Question 6

Rotator cuff tear

Answer 6

Can be partial (still attached) or a complete tear (separated fully)
Caused by injury (fall breaking collar bone or dislocating shoulder) or degeneration (wear and tear, bone spurs rubbing, decreased blood supply)
Over 40 for degenerative
Risks- family history, poor posture, smoking, repetitive shoulder movements from jobs or hobbies
Symptoms- difficulty/ pain when raising arm, crepitus, shoulder pain worsening at night/ resting arm, Shoulder weakness
Prognosis- doesn’t heal on own without surgery but can improve functionality and decrease pain non surgically- rest, sling, NSAIDs, physical therapy, steroid injections

Question 7

Shoulder instability

Answer 7

=loss of shoulder function and comfort due to undesirable translation of humeral head on glenoid fossa
Caused by ligaments or labrum becoming stretched, torn or detached
Any age
Risks- genetic conditions (born with loose ligaments or joints), people previously suffering from shoulder dislocation
Symptoms- ball of shoulder coming out of socket, pain, giving way with certain activities, decreased ROM, swelling, bruising
Prognosis- aim is to restore shoulder motion and increase muscular strength, rest, sling, shoulder bracing, strengthening exercises, NSAIDs

Question 8

Frozen shoulder (adhesive capsulitis)

Answer 8

=capsule thickens and tightens around shoulder joint caused by keeping shoulder still for too long
Common over 40
Risks- recently had surgery, recent arm break, women, rotator cuff injury, people with underlying diseases (E.g. diabetes)
Symptoms- freezing stage- pain when moving, limited ROM. Frozen stage- shoulder stiff and hard to use. Thawing stage- ability to move improves
Prognosis- gets better in 1-3 years. ROM exercises, corticosteroids, numbing medications