Shoulder main ones Flashcards
Subacromial Impingement
Inflammation and irritation of the rotator cuff tendons as they pass through the subacromial space
are >40
Some people are thought to be born with a “hooked” acromion that will predispose them to impingement.
Other Pts develop impingement due to intrinsic rotator cuff weakness.
Overactivity - sports or work related activities, that involve overhead motion.
Localised tenderness, inflammation
Pain with limited ROM
Calcific Tendinitis
Hard calcium deposits form on soft tissue for reasons unknown.
May stem from:
- genetic predisposition
- abnormal cell growth/thyroid gland activity
- metabolic diseases, such as diabetes
- heavy lifting, or play sports like basketball or tennis.
Between 40 and 60 years old. Women more likely to be affected than men.
Sudden shoulder pain or stiffness.
Intense pain with shoulder movement.
Severe pain that disrupts sleep.
Reduced range of motion.
Rotator cuff tenderness.
A/C Joint Arthritis
Smooth cartilage surface covering the joints becomes thin and rough. The ends of the bone can then rub together causing pain
Irritation of underlying subacromial bursa by inferior projecting osteophytes from AC joint
Middle aged onwards- overuse
Occupational heavy lifting, manual work, repetitive micro-trauma (weight lifting, swimming, basketball)
Dull ache from deltoid area, commonly point to top of the shoulder, exacerbated by motion
Horizontal adduction the most symptom provoking
Pt may complain of inability to sleep on affected side of body
Rotator Cuff Tear
Traumatic injury or high stress e.g. baseball pitcher
Older, rotator cuff loses elasticity, becomes more susceptible to injuries, often damaged when performing everyday activities
Some occupations - Jobs that require repetitive overhead arm motions, such as carpentry or house painting, can damage the rotator cuff over time
Pain felt over outside of shoulder and upper arm, lateral delt and biceps
Pt may describe generalised discomfort that’s exacerbated by certain movements
Limited ROM
Pt may complain of crepitus, catching and stiffness
Decreased strength
A complete tear may result in an inability to move the shoulder, however, some patients demonstrate minimal functional limitations with a tear
Shoulder Instability
- Unidirectional typically result of trauma - damage to structures in the shoulder such as ligaments, tendons, labarum (the rim of cartilage) or humerus
- Multidirectional typically atraumatic - people who naturally have greater laxity (looseness) in their joint and surrounding tissues.
Adolescents
Unidirectional - more males - dislocations
Multidirectional - females - athletic activities that repetitively use the GH joint - swimming
Pain
Varied degrees of instability, the sensation of a joint subluxation (partial dislocation)
Unidirectional anterior instability, the patient can typically localise the pain or instability to the position of shoulder abduction and external rotation and often can remember a specific event that may have brought on the symptoms.
These Pts may have suffered a dislocation in the past
Multidirectional instability, the classic presenting complaint is pain, and patients may experience symptoms during daily activities with seemingly insignificant provocation.
Shoulder Arthritis
OA most common
Pts over 50, more common in women
Past shoulder injury
Weight
Occupations, such as heavy construction or overhead sports
- Pain in the affected shoulder
- Shoulder stiffness is also a frequent problem, and Pts may note a sensation of crepitus with shoulder movement.
- Symptoms begin gradually and are chronic and progressive.
- Discomfort is typically worsened with activity, and Pt may awaken at night from pain, particularly if they sleep on the affected shoulder.
- Functional limitations may be evident, including an inability to perform overhead activities or reach behind the back or under the opposite axilla with the affected arm.
Tuberculous Arthritis
Uncommon
Pts usually adults
* Constant aching and stiffness lasting months
* Striking feature – wasting of muscles around the shoulder
* Diffuse warmth and tenderness, all movements limited and painful
* Axillary lymph nodes may be enlarged
Frozen Shoulder (Adhesive Capsulitis)
Capsule thickens and tightens around the shoulder joint, restricting its movement.
Primary frozen shoulder - Fully restricted ROM, is idiopathic, while secondary frozen shoulder - Limited ROM, is associated with another medical condition. Most commonly diabetes mellitus
Older than 40, More women
Having to keep a shoulder still for a long period increases the risk of developing frozen shoulder. This might happen after having surgery or breaking an arm.
Pain and loss of range of motion in the shoulder.
* Diagnosis is one of exclusion, shouldn’t be made until everything else is ruled out
* Traditionally progress through three overlapping clinical phases during a period of 18 to 24 months. The initial or “inflammatory” phase (a few weeks to 9 months) is characterised by the insidious onset of pain and stiffness around the shoulder.
* During the second or “adhesive” phase (4– 12 months), the pain gradually subsides but the stiffness persists.
* The final or “resolution” phase (5– 24 months) is characterised by a spontaneous but gradual improvement in range of motion.
The rotator cuff syndrome
Any injury or degenerative condition affecting the rotator cuff - subacute tendinitis, chronic tendinitis, and rotator cuff tears
- Degeneration- age – micro tears- potential scarring, calcium
- Trauma/impingement- supraspinatous= liability to injury, e.g., lifting weight, or stop yourself falling
- Shoulder P/weakness
- Onset may be sudden
- P typically appears over front/lateral aspects of shoulder, tenderness felt at ant edge of acromion
- Always compare to other shoulder
Bicep tendinitis
Lies adjacent to rotator cuff, may be involved in impingement.
Pain and tenderness sharply localised to bicipital groove.
Stressing biceps tendon will provoke pain.
Rest, local heat provides relief.
Torn long head of biceps
Common in middle aged to elderly Pts after degeneration has occurred.
Lifting heavy object – feels something sharply snap.
Shoulder then aches for a period of time and bruising may appear.
Belly of bicep contracts into a prominent lump after recovery.
Treatment unnecessary unless function is disturbed.
SLAP lesions
Damage to cartilage that connects your arm to your shoulder
- A fall on an outstretched arm can damage the superior part of the glenoid labrum anteriorly and posteriorly (SLAP).
- Usually history of a fall followed by pain in the shoulder.
- Initial acute symptoms settle left with painful clicking when lifting arm above shoulder height and loss of power.
- Inability to throw with injured arm
- MRI arthrography best to diagnose
- Treated by reattachment or debridement
Rapidly destructive shoulder arthropathy
- Pt presents with swelling of the shoulder and x-rays show bizarre form of arthritis.
- Crystal induced, rapidly progressive arthropathy
- Sometimes associated with massive tears of the rotator cuff
- No satisfactory treatment
- Arthroplasty may relive pain but will not improve joint function as joint is unstable
