Shoulder Pain

Question 1

Rotator cuff muscles and their functions

Answer 1

SITS
1. Supraspinatus - abduction 2. Subscapularis - internal rotation
3. Infraspinatus - external rotation (teres minor, biceps as well)
4. Pectoralis major - Adduction
(Latissimus dorsi as well)

Question 2

mcc of shoulder pain

Answer 2

Rotator cuff tendonopathy/Subacromial impingement syndrome
1. Esp in young who plays sports (over head activities like basket ball) or >50yrs
2. Causes: tendon tear/infl, calcification, amyloidosis

Question 3

Rotator cuff vs Adhesive capsulitis (frozen shoulder)

Answer 3

MOVEMENT: shoulder pain
Rotator cuff - painful arc involving one muscle
AC - Pain in all directions, marked stiffness

Question 4

Supraspinatus tendonopathy cause, examinations

Answer 4

1. Sudden pull on shoulder (dog on leash)
   2.Throbbing pain, around deltoid

Examinations:
1. Drop arm test
2. Empty can sign
3. Near sign
4. Hawkins sign
Any one sign + suggests

Confirm diagnosis with High resolution USG
Rx- PCM, NSAID, steroid inj, physio, Sx rare cases(not improved in 3-6months)

Question 5

Rotator cuff tear diagnosis

Answer 5

1. Supraspinatus weakness
2. External rotation weakness
3. Impingement in external/internal rotation

Any 2/3+ … Diagnosis, esp >60yrs

Question 6

Subacromial bursitis mx

Answer 6

Hospital admission for pain mx
PCM/codeine
*Steroid inj 1ml into bursa

Question 7

Adhesive capsulitis

Answer 7

1. Inflammation .. fibrosis, contraction of
   Glenohumeral joint
2. Spontaneous/injury/DM
3. Stages:
   Freezing..frozen..thawing - infl phase (2-9mo)
   Fibrotic/contracted (frozen)phase - (4-12mo)
   Resolution(partial/complete) - (5-26mo)
4. Deep, throbbing, constant pain
5. External rotation first affected
6. Confirm diagnosis: High resolution USG

Question 8

Rupture of biceps tendon

Answer 8

POPOYE sign - lump on flexing elbow
Active rx not indicatied
Young, atheletic - SX