shoulder pain Flashcards
rotator cuff disorders
tendinopathy
partial tear
complete tear
progressive fibrosis of joint capsule → painful loss of shoulder ROM
later on: reduction in pain, then return to near normal ROM
*loss of active + passive ROM
adhesive capsulitis
osteoarthritis: degeneration of articular cartilage with associated synovitis, effusion, osteophyte formation
glenohumeral (trauma, dislocation hx, autoimmune arthritis, loss of active + passive ROM)
acromioclavicular (most common, overhead activities, heavy weight lifting, may have prominent AC joint)
shoulder instability
subluxation
dislocation
shoulder anatomy
humerus
clavicle
scapula: acromion, coronoid, glenoid
shoulder joint articulations
sternoclavicular
acromioclavicular
glenohumoral
scapulothoracic
soft tissue stabilizers of shoulder joint
static: bony support, joint capsule, glemohumeral ligaments, glenoid labrum dynamic stabilizers (keep humerus centered in glenoid during movement): rotator cuff muscles, long head of biceps tendon
rotator cuff muscles
loss of active ROM ONLY "painful arc": pain with active ROM between 60-120 deg supraspinatous infraspinatous teres minor subscapularis
if weak static or dynamic stabilizers
risk for shoulder subluxation (transient dislocation) or frank dislocation
most common shoulder subluxation/dislocation
anterior
fall with arm abducted and externally rotated
complication of subluxation/dislocation
damage to labrum - lead to chronic instability/dislocations
repetitive overhead activities
recurrent impingement of rotator cuff between humerus and acromion
tendinopathy (inflammation) → partial tear → complete tear of rotator cuff tendon
impingement syndrome
occurs secondary to primary rotator cuff injury
subacromial bursitis
abduction strength tests (arm at 90)
supraspinatous
internal rotation strength tests
subscapularis
external rotation
infraspinatous/teres minor
hawkins impingement test: passively forward flex arm to 90, internally rotate arm to end point
rotator cuff injury:
trap rotator cuff tendon (often supraspinatous) between bony head of humerus and undersurface of acromion
positive: pain
empty can test: abduct to 90, forward flex the arm 30 deg
supraspinatous injury (more effective than abduction strength test) positive: pain + weakness
subscapularis lift oft=F test: dorsum of hand against low back - pt lifts hand off and examiner resists
subscapularis
positive: pain and/or weakness
drop arm test: passively abduct to 160 degrees, ask pt to slowly lower arm to side
large rotator cuff tear needing surgery:
positive: arm not lowered in controlled fashion
AC joint test
bring patients arm across contralateral shoulder (adduction)
positive: pain in AC joint
apprehension test: lie supine, abduct to 90 deg with elbow flexed to 90 deg, examiner applies external rotation
anterior shoulder instability/DISLOCATION
positive: apprehensive
sulcus sign: examiner applies inferior force down on wrist
multidirectional instability
positive: suclus or indentation is created between acromion and proximal humeral head
acute injury, arthritis, calcific tendinosis - imaging
xray
if fail conservative management for 6-8 wks
MRI and suspect rotator cuff tear
