Shoulder pain

Question 1

What’s impingement syndrome/ painful arc?

Answer 1

Entrapment of supraspinatus tendon and subacromial bursa between acromion and grater tuberosity of humerus → subacromial bursitis and/or supraspinatous tendonitis

Question 2

Presentation of impingement syndrome

Answer 2

• Painful arc: 60-120 °
• Weakness and ↓ ROM
• +ve Hawkin’s test

Question 3

Ix of impingement/painful arc syndrome

Answer 3

• Plain radiographs: may see bony spurs
• US
• MRI arthrogram

Question 4

Management of impingement/ painful arc syndrome

Answer 4

Conservative

• Rest
• Physiotherapy

Medical

• NSAIDs
• Subacromial bursa steroid ± LA injection

Surgical

• Arthroscopic acromioplasty

Question 5

Presentation of Adhesive Capsulitis

Answer 5

Adhesive Capsulitis = Frozen Shoulder

• Progressive ↓ active and passive ROM

• ↓ ext. rotation <30°
• ↓ abduction <90°

•Shoulder pain, esp. @ night (can’t lie on affected side)

• external rotation is affected more than internal rotation or abduction
• both active and passive movement are affected
• patients typically have a painful freezing phase, an adhesive phase and a recovery phase
• bilateral in up to 20% of patients
• the episode typically lasts between 6 months and 2 years

Question 6

What’s adhesive capsulitis/frozen shoulder?

Answer 6

Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain. It is most common in middle-aged females. The aetiology of frozen shoulder is not fully understood

• cause unknown, may follow trauma in elderly
• Commonly assoc. c¯ DM

Question 7

How long is the episode of adhesive capsulitis?

Answer 7

between 6 months and 2 years

Question 8

Treatment of adhesive capsulitis/ frozen shoulder

Answer 8

Conservative: rest, physio

Medical

• NSAIDs
• Subacromial bursa steroid ± LA injection

Question 9

What’s rotator cuff tear?

Answer 9

• Damage to one of rotator cuff’s muscles/tendons
• supraspinatus is most commonly damaged

Question 10

Causes of rotator cuff tear

Answer 10

• degeneration and arthritis (usually elderly)
• sudden jolt or fall
• may occur in young competitive overhead throwers

Question 11

Presentation of rotator cuff tear

Answer 11

Partial tears → painful arc

Complete tear

• Shoulder tip pain
• Full range of passive movement
• Inability to abduct the arm
• Active abduction possible following passive abduction to 90°
• Lowering the arm beneath this → sudden drop
• “drop arm” sign

Question 12

Management of rotator cuff tear

Answer 12

A. Partial tear: physiotherapy and local anaesthetics

B. Complete tear: open or arthroscopic repair

Question 13

What’s subacromial bursitis?

Answer 13

Impingement of subacromial bursa

Cause:

• inflammatory arthropathy
• osteophytes
• trauma

Question 14

Treatment of subacromial bursitis

Answer 14

local anaesthetic injection into bursa