Shoulder pain

Question 1

Muscles in rotator cuff

Answer 1

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

Question 2

Supraspinatus: movement and innervation

Answer 2

Abducts

Suprascapular nerve

Question 3

Infraspinatus: movement and innervation

Answer 3

External rotation

Suprascapular nerve

Question 4

Teres minor: movement and innervation

Answer 4

External rotation

Axillary nerve

Question 5

Subscapularis: movement and innervation

Answer 5

Internal rotation

Upper and lower subscapular nerve

Question 6

Stages of tendon self-repair(3)

Answer 6

Inflammation
Proliferation
   - newly formed type III collage
Remodelling
   - type III replaced with type I

Question 7

Tendonitis pathophysiology

Answer 7

Microtears due to acute overloading

Inflammation

Question 8

Tendonopathy pathophysiology

Answer 8

Degenerative process due to chronic overloading

No inflammation

Question 9

Rotator cuff tear, presentation

Answer 9

Pain, reduced movement

Glenoid head not held in socket

Question 10

Rotator cuff tear, management

Answer 10

Conservative - analgesia, physiotherapy
Injection - steroid and LA into subacromial space
Surgical intervention

Question 11

Steroid injection factors to remember

Answer 11

Anticoagulation
Diabetes (might inc sugars, higher risk of infection)
Systemically well
Allergies

Question 12

Steroid injection risks

Answer 12

Fails to work
Infection
Pain
Temporary worsening of symptoms
Bruising, bleeding

Question 13

Types of surgical intervention for rotator cuff tear

Answer 13

Repair tear
- sutures and bone anchors, reattach cuff to greater tuberosity
Subacromial decompression
- helps with above
- remove inflamed tissue, creates space for gliding
Arthroplasty
- if also arthritis

Question 14

Differentials for shoulder pain

Answer 14

OA
RA
Referred pain from neck
Rotator cuff tear
Frozen shoulder
Subacromial impingement syndrome
Bursitis

Question 15

Frozen shoulder, pathophysiology

Answer 15

“Adhesive capsulitis”
Capsule thick and tight, can’t move
Bands of scar tissue
Less synovial fluid

Question 16

Frozen shoulder, three phases

Answer 16

Freezing phase
Frozen phase
Thawing phase

Question 17

Frozen shoulder: Freezing phase

Answer 17

Pain on movement, worsens
6-9 months
Movement limited

Question 18

Frozen shoulder: Frozen phase

Answer 18

Pain may get better
More stiffness
4-12 months

Question 19

Frozen shoulder: Thawing phase

Answer 19

Range of motion starts to return to normal

6 months to 2 years

Question 20

Frozen shoulder management

Answer 20

Basic pain relief (paracetamol, ibuprofen)
Stronger painkillers
Steroid injections
Physiotherapy

Question 21

Subacromial impingement syndrome (SAIS) definition

Answer 21

Inflammation and impingement of rotator cuff tendons as they pass through the subacromial space

Question 22

SAIS features

Answer 22

Pain, worse on lifting arm above head
Weakness
Reduced ROM

Question 23

Types of injury in SAIS

Answer 23

Tendonitis
Bursitis
Calcific tendonitis
Tendonopathy
Tears (partial or complete)

Question 24

Management of SAIS

Answer 24

Painkillers
Heat/ice
Exercises
Steroid injections
Surgical intervention - subacromial decompression

Question 25

Imaging for shoulder pain

Answer 25

Plain x ray (may pick up cancers, see joint surface)
MRI (rotator cuff injury, subacromial bursitis/fluid)
USS (rotator cuff injury, subacromial bursitis/fluid)
- can image during movement