Shoulder Conditions Flashcards
Subacromial impingement syndrome
Most common cause of shoulder pain
When the tendons of the rotator cuff muscles and or the subacromial bursa become compromised between the coracoacromial arch and proximal humerus. The impingement can lead to inflammation, pain, and limited ROM in the shoulder.
Casues - Repetitive overhead movements, shoulder trauma and injury, anaotmical variations in the shape of the acromion, muscle wekaness or imbalance
Symptoms - Pain when raising or lowering the arm, pain or discomfort on external rotation or reaching behind your back, weakness and loss of strength in the shoulder, difficulty reaching overhead, pain at night especially when lying on the affected shoulder
Generic term for multiple causes of impingement pain between coracoacromial arch
Accounts for 65-85% of shoulder pain
Age- >40yo M=F
SAPS Cluster
“SAPS” stands for “Sensitivity, Acromion, Painful arc, Strength,”
- Sensitivity: This component refers to tenderness or pain experienced by the patient upon palpation or touching of specific areas around the shoulder joint, particularly the anterior and lateral aspects of the acromion.
- Acromion: The shape and morphology of the acromion can contribute to shoulder impingement. Variations such as a hooked or curved acromion may increase the risk of impingement by narrowing the subacromial space and compressing the underlying structures, including the rotator cuff tendons and subacromial bursa.
- Painful Arc: Shoulder pain that occurs during certain ranges of motion, particularly between 60 to 120 degrees of shoulder abduction, is known as the “painful arc.” This component assesses whether the patient experiences pain or discomfort during this specific range of motion, which is often indicative of impingement of the rotator cuff tendons and subacromial structures.
- Strength: Weakness or loss of strength in the muscles around the shoulder joint, particularly the rotator cuff muscles, may be observed in patients with shoulder impingement syndrome. Assessing shoulder strength through manual muscle testing or functional movements can provide valuable information about the integrity of the rotator cuff and surrounding musculature.
Adhesive capsulitis (Frozen shoulder)
Frozen shoulder (adhesive capsulitis)
Inflammatory condition causing stiffness and pain in the shoulder joint.
Primary - Typically idiopathic and has a gradual onset, often associated with underlying conditions such as diabetes, mellitus, thyroid disease, drugs or cervical spontylosis
Secondary - Typically the result of a shoulder injury, such as a rotator cuff tears, fractures, surgery.
- Also known as adhesive capsulitis is a self-limiting inflammatory condition where tissues around the shoulder become inflamed alongside joint capsule stiffness and can cause shoulder pain and a progressive loss of ROM.
- In 50% of patients it affects both shoulders.
- Comes in 3 stages Freezing, Frozen and Thawing
- It affects 3-5% of the population with and age range of 50-70 y/o
- It is more common in Females than Males, diabetic and sedentary workers
- Bilateral in up to 40-50%
- Most common in women aged 40- 65 years and sedentary workers
Synovitis leads to fibrosis across the glenohumeral joint causing capsular tightness and stiffness esp. with external rotation and abduction.
o Commodities including: Diabetes mellitus (10-36%)/Hyperthyroidism/ hypothyroidism/ Parkinson’s disease / cardiac disease/ stroke
Frozen Shoulder Phases
o Three Phases;
- Phase 1 (freezing): early synovial inflammation > little restriction, increasing pain lasting between 2 to 9 months
- Phase 2 (frozen): thickened synovium due to increased inflammation > severe pain; adhesion growing > increasing stiffness, thus pain and decrease ROM in all directions lasting 4 to 12 months
- Phase 3 (thawing): decreased inflammation > pink synovium, decreased pain and increasing motion, lasting 6 to 9 months
Rotator cuff tendinopathy
-Describes the pain and swelling of the rotator cuff tendons due to damage or dysfunction and most commonly affects the supraspinatus tendon as it sits below the acromion making it vulnerable to impingement with overhead activity. This can lead to conditions that are associated or caused by rotator cuff tendinopathy including, rotator cuff tears, subacromial bursitis and impingement syndrome which account for 65-85% of all shoulder pain.
-It is most common in Athletes, elderly people and occupations that require repetitive arm movements or overhead work.
-Symptoms include pain during activity, and weakness and limited ROM can also be present
Prevalence increases with age >30 yo
Associated with repeated over head activities.baseball, painters
Caused by tensile stress on the tendon or compression afternoon within subacromial space.
Tendinitis Vs Tendinopathy
Tendinitis - Refers to the inflammation of the tendon, characterised by acute inflammation of the tendon, often as a result from overuse or injury. Causes are repetitive movements, overuse or sudden injury. Symtpoms include pain, swelling and tenderness
Tendinopathy - Is a broader term that refers to a general problem with the tendon. It includes conditions such as degeneration without significant inflammation. Pathology includes both inflammation and degenerationn of the tendon tissue. Causes are overuse, repetitive strain, aging and degenerative changes. Symptoms include stiffnes, pain, impaired function which may develop gradually and owrsen overtime.
Stages of Impingement (Neer’s Classification);
o Stage 1;
* Patients under 25 years old with painful arc
* A reversible condition due to oedema and haemorrhage in the supraspinatus tendon
* Minimal pain (like toothache) with activity, but no restriction or weakness of motion
* Be aware that atrophy of the rotator cuff muscles may be present.
o Stage 2;
* Patients between 25 and 40 years
* Marked reactive tendinitis with significant pain between 70º and 120º of active abduction.
* Inflammation may affect the biceps brachii tendon and subacromial bursa, leading to thickening and possible permanent fibrotic changes in structure
* Limited active ROM in external rotation and abduction
* Possible clicking sounds on resisted adduction and internal rotation
o Stage 3;
* Patients over 40 years old with chronic shoulder pain
* Severe tendon degeneration and partial rupture
* Significant weakness with disuse atrophy and superior migration of humeral head
* May have prominent capsular laxity with Multidirectional instability.
Rotator cuff tear
-Is tearing of the muscles in the shoulder including the supraspinatus, infraspinatus, teres minor and subscapularis.
-Is tearing of the muscles in the shoulder including the supraspinatus, infraspinatus, teres minor and subscapularis.
-It can be cause by acute injury such as humeral fracture or dislocations or by degeneration due to aging.
-Partial tears usually have an age range of 30-55 y/o and can extend to full tears which are associated with over 40 y/o
-Symptoms: sharp pain and weakness of shoulder, arm cannot lift more than 30 degrees
Increases risk with age
MC >60yo M=F
caused by tensile stress on the tendon or compression of the tenant within subacromial space.
Develops from partial tear to full thickness tear
Associated factors include a history of trauma, limb dominance, smoking an occupational jobs.
Bicipital tendinopathy
Overuse, direct blow, laxity of the transverse ligament resulting in subluxation, chronic irritation (secondary to rotator cuff tendinitis), or anatomical reasons such as a narrow or shallow bicipital groove
The shoulder capsule is lined with synovium and the sheath of the long head of biceps tendon is an extension of the shoulder joint synovial lining
Tenosynovitis is usually found under or just distal to the transverse humeral ligament
HADD / Calcific Tendinitis
Calcifying Tendinitis;
Unknown aetiology, it is not related to rotator cuff degeneration, tendon tears or trauma. It may be an autoimmune disease.
Calcium deposit is usually in the body of the tendon
Most common muscles involved are the supraspinatus and infraspinatus
Most common in 30-50year old females
Sudden onset of a very painful shoulder
Almost all-resistive and passive tests are positive
Self limiting 6-14 days
Bursitis
- Of the 8 bursae around capsule the large subacromial bursa has the most clinical significance.
- The bursa is bounded superiorly by the coracoacromial ligament and acromion and inferiority by the rotator cuff and capsule.
- Virtually all cases of subacromial bursitis are secondary, associated with either a rotator cuff tendonitis, biceps tenosynovitis or another inflammatory process in the bone or joint.
Clinical;
o Acute: Severe pain, all active shoulder movements painful
o Chronic: Symptoms are vague. Patient may complain of pain, only after excessive overhead use or may complain of a dull diffuse ache. Night pain is common.
MC- middle aged Female seen and people working repetitive overhead activities, such as painting, athletes, and factory workers.
Most common bursa is the subacromial can also affect the subscapular bursa
Anterior Dislocation
Mc in male younger patients 16-30 yo
Types: anterior (95%), posterior, inferior and superior
Anterior dislocation is caused by falling in a position of extreme external
rotation with abduction or hyperextension or by posterior force on the
posterior or posterolateral side
OA
Mc in older women >60
Mc in AC joint, OA changes to the AC joint can develop by the 2nd decade and are universal
after the age of 50
Associated with clavicle fractures and shoulder dislocations around AC
Caused by degenerative aging within the glenoid fossa and head of humerus
S/S:
Pain
Stiffness
Reduced ROM
Worsens with activity
Glenoid laboral tear
- Labrum is a fibrocartilage attached to the rim of the shoulder socket and when torn it is called a labral tear.
- They can be further classified into SLAP lesion, Bankart lesion or posterior labral tear
- They can be caused by trauma such as a fracture or dislocation and tend to affect people that do weight lifting, throwing sports and overhead sports.
- Symptoms include pain, shoulder instability, weakness and loss of ROM
Fractures
- Fracture of humerus
Posterolateral compression fracture of humeral head (Hill-Sachs lesion), avulsion fracture of inferior glenoid process (Bankart lesions) - 75 % of anterior dislocation - Fracture of clavicle
Fall or direct impact, most common birth fracture and fracture in children - Fracture of scapula
Direct blow
Usually associated with fractures of ribs and/or thoracic spine
