Shoulder Pain and Soft Tissue Pathologies

Question 1

what are two causes of shoulder pain?

Answer 1

bony (fractures and osteoarthritis) and soft tissue (rotator cuff tendons, bursae and frozen shoulder) pathologies

Question 2

where can should pain be referred from?

Answer 2

cervical spine or chest

Question 3

what are bursae?

Answer 3

fluid filled sacs between a tendon and a muscle that reduce friction allowing the muscle to move freely and reducing inflammation

Question 4

how do we assess pain and describe each stage?

Answer 4

SOCRATES
S - site
O - onset
C - character
R - radiation  
A - associated factors 
T - time 
E - exacerbating AND alleviating factors 
S - severity

Question 5

how do we examine the shoulder joint?

Answer 5

LFM - look, feel, move

Question 6

how would you know if there is a muscular or tendinous problem?

Answer 6

if the patient struggles to move their arm, but it is fine moving when the muscle is relaxed

Question 7

where is the subacromial bursa?

Answer 7

between the supraspinatus tendon and acromion

Question 8

how can this bursa become inflamed?

Answer 8

repetitive abduction of the shoulder

Question 9

what is the term for calcium deposits in the tendons of the rotator cuff?

Answer 9

calcific tendonitis

Question 10

what happens in adhesive capsulitis?

Answer 10

in frozen shoulder the capsule around the joint becomes very tight so movement is limited in all direction

Question 11

what is the role of supra and infraspinatus? how would you test these?

Answer 11

supraspinatus - initiates the abduction of the arm - first 15 degrees - test by abducting the arm against resistance form 0 degrees
infra - lateral rotation of the humerus - test by laterally rotating the arm against resistance - same of teres minor

Question 12

what is the innervation of supra and infraspinatus?

Answer 12

suprascapular nerve

Question 13

which muscle does the axillary nerve supply in the rotator cuff?

Answer 13

the teres minor

Question 14

what is the action, innervation and test for subscapularis?

Answer 14

medial rotation and adduction of humerus, it is innervated bu the upper and lower subscapular nerves of C5-6 and is tested by placing the dorsum of the hand to the mid-lumbar spine and then lifting the dorsum of the hand off of the back

Question 15

which rotator cuff muscle tendon is most likely to become inflamed in tendonitis?

Answer 15

the tendon of the supraspinatus as it is below the acromion

Question 16

what does subacromial bursitis result in?

Answer 16

inflammation of bursa which narrows the space causing impingement of the supraspinatus tendon when the muscle contracts. This causes a painful arc where there is pain between 60-100 degrees of abduction

Question 17

where is calcific tendonitis most common?

Answer 17

the supraspinatus tendon

Question 18

when is calcific tendonitis worse?

Answer 18

at night and on movement