Shoulder pain and its causes Flashcards
adhesive capsulitis
frozen shoulder syndrome chronic inflammation and fibrosis and contracture of joint capsule
Treatment of adhesive capsulitis
more stiffness than pain with inability to reach objects or rotate shoulder >50% reduction in PROM or AROM Self limited condition and responds to conservative management with Stretching exercises as treatment of choice.
pain with abduction, external rotation of shoulder subacromial tenderness and normal ROM positive impingement tests (neer’s and hawkins), think:
rotator cuff impingement or tendinopathy
similar presentation to rotator cuff tendinopathy but with weakness with abduction and external rotation age >40 yrs old
rotator cuff tear
stiffness and pain and decreased passive and active ROM
adhesive capsulitis (frozen shoulder)
anterior shoulder pain, pain with lifting, carrying or overhead reaching and weakness is less common
biceps tendinopathy or rupture
gradual onset of anterior or DEEP shoulder pain and decreased active and passive abduction or external rotation. caused by trauma and generally uncommon
glenohumoral osteoarthritis.
Milwaukee shoulder
basic calcium phosphate deposition disease (similar to CPPD) that results in subacute shoulder arthropathy and large hemorrhagic effusion. This destroys the joint involving the glenohumoral joint and rotator cuff.
XR of a Milwaukee shoulder
perarticular calcification and destructive arthritis. MRI can help delineate pathology better. Synovial fluid is hemorrhagic and has basic calcium phosphate crystals that are not seen under polarized microscopy.
diagnosis of milwaukee shoulder
clinical diagnosis as cannot evaluate fluid for the calcium phosphate crystals.
synovial fluid analysis of osteoarthritis is
non inflammatory and WBC<2000
osteosarcoma is seen in
kids and adolescents and see a soft tissue mass that is palpable
Gout and Pseudogout are two separate conditions. Do they present with joint destruction and hemorrhagic effusions on joint aspiration?
no. rarely see bloody effusion or synovial fluid.
smoker and shoulder pain and paresthesias in their hadn
pancoast tumor, get a CXR
manifestations of superior pulmonary sulcus tumor or pancoast tumor?
shoulder pain, horner’s syndrome (invasion of paravertebral sympathetic chain, stellate ganglion) and see neurological symptoms (invasion of C8-T2) with weakness, atrophy of intrinsic hand muscles, pain and paresthesias of 4th 5th digits and medial arm/forearm supraclavicular LAD weight loss
shoulder pain
when do people get rotator cuff tears?
seen in people >40 yrs after a fall braced by an outstretched arm.
pain in lateral deltoid that is worsened by raising arm or overhead activity and pain and external rotation
positive drop arm test
weakness in external rotation
MRI and MSK u/s can accurately diagnose the rotator cuff tear. Treatment involves surgery and best results occur within 6 weeks of injury.
Shoulder impingement
Start with XR to rule out arthritis
CT shoulder next to rule out masses
MRI shoulder will make the diagnosis. it’s preferred
can treat with cortisone shot in the hsoulder bursa to diagnose impingement if it’s effective in relieving pain.
how to treat a neurogenic thoracic outlet syndrome?
thoracic outlet syndrome 1st line tx
physical therapy - aimed at shoulder girdle muscle strengthening and improving posture
what is thoracic outlet syndrome?
compression of brachial plexus, subclavian artery, subclavian vein as a these structures pass through the thoracic outlet.
3 subtypes: derived by the structure involved: nerve, artery, vein
neurogenic TOS is the most common
compression of brachial plexus nerve roots as they exit the triangle formed by the 1st rib and the scalenus anticus and medius muscles.
symptoms of thoracic outlet syndrome?
parethesias, pain, that worsen with activties that involve continued use of arm or hand especially those that include elevation of the arm.
no abnormal neurogenic findings
EMG won’t see anything
1st line therapy for neurogenic TOS includes improving posture and strengthening should girdle muscles.
