Shoulder pain

Question 1

Adhesive Capsulitis : Definition

Answer 1

Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain. It is most common in middle-aged females.

Caused by : Inflammation and Thickening of the Joint Capsule: which can result in adhesions forming

Question 2

Adhesive Capsulitis : Clinical symptoms

Answer 2

Typically occurs unilateral
* Pain:
* Shoulder pain worse on movement
* Stiffness:
* Gradual onset of stiffness in the shoulder joint is a key feature.
* Limited Range of Motion:
* External rotation is affected the most
* Active and Passive movement affected
* Difficulty Sleeping:
* Pain when sleeping on affected side

the episode typically lasts between 6 months and 2 years

Question 3

Adhesive Capsulitis : Occurence

Answer 3

1. Middle aged women
2. Diabetes Mellitus

Question 4

Adhesive Capsulitis : Management

Answer 4

treatment options include NSAIDs, physiotherapy, oral corticosteroids and intra-articular corticosteroids

Question 5

Rotator cuff : Abduction

Answer 5

Supraspinatus Muscle and Tendon:

MOA : Abduction - lifting arm away from the body
Responsible for 0-15 degrees - initation of abduction, then deltoid takes over

Anatomy
Origin : top of the shoulder blade (scapula)
Insert : onto the upper part of the humerus (upper arm bone).

Question 6

Rotator cuff : External rotation

Answer 6

MOA of both : Externally rotate arm
* Rotating arm outwards and reaching behind body

Infraspinatus Muscle
Origin : the back of the shoulder blade (scapula)
Insert : into the humerus.

** Teres Minor Muscle**
Origin : situated beneath the infraspinatus on the scapula
insert : into the humerus.

Question 7

Rotator cuff : Internal rotation

Answer 7

MOA : Internal rotation of arm

Origin : front of the shoulder blade
Insert : into the humerus.

Question 8

Rotator cuff injury : Spectrum

Answer 8

1. Subacromial impingement (also known as impingement syndrome, painful arc syndrome)
2. Calcific tendonitis
3. Rotator cuff tears
4. Rotator cuff arthropathy

Question 9

Subacromial impingement : Pathophysiology

Answer 9

The subacromial space :
* is the area beneath the acromion (a bony projection of the scapula) and above the head of the humerus (upper arm bone).

Subacromial impingement
where the structures in the subacromial space of the shoulder become compressed or irritated, leading to pain and dysfunction.

This can be due to - inflammation of the synovium or tendon causing narrowing of the space

Question 10

Subacromial impingement : Clinical presentation

Answer 10

Abduction may be worst affected as ;
Supraspinatus muscle passes through the subacromial space and can be compressed during certain shoulder movements.

1. Painful Arc
   Pain at 60-120 degrees of arm elevation - subacromial space is the most narrow and supraspinatus tendon is most vulnerable to impingement

2 . Shoulder pain
* Tendernes over acromion

3 . Weakness and limited range of movement
* Difficulty in raising arm
* Difficulty in abduction
* Painful external rotation