Shoulder Pathology

Question 1

What is acute rotator cuff tendonitis?

Answer 1

AKA calcific tendonitis

Deposition of calcium phosphate in supraspinatus tendon causing intense inflammatory reaction and swelling

Question 2

What are the symptoms of acute rotator cuff tendonitis?

Answer 2

Aching pain

Pain increases and then resolves

Question 3

What are the signs of acute rotator cuff tendonitis?

Answer 3

Arm immobile

Too tender to palpate

Question 4

What is the management of acute rotator cuff tendonitis?

Answer 4

Rest arm in sling
NSAIDs
Severe pain-intra capsular steroid or lidocaine injection

Condition resolves over 1-3wks

Question 5

What is chronic rotator cuff tendonitis?

Answer 5

Over use or minor tears of rotator cuff

Causes subacute or chronic vascular response leading to pain and stiffness

Question 6

What are the symptoms of chronic rotator cuff tendonitis?

Answer 6

Pain in shoulder

Worse at night or when abducting/elevating arm

Question 7

What are the signs of chronic rotator cuff tendonitis?

Answer 7

Tender just beneath anterior edge of acromion 
Painful arc at 60-120 degrees
Less pain when passively abducted
Power normal
-separates from tear

Question 8

What is the management of chronic rotator cuff tendonitis?

Answer 8

Analgesia-NSAID
Steroid injection
Physio
Surgery=last resort

Question 9

What is a rotator cuff tear?

Answer 9

Caused by trauma in young patients or spontaneously in older patients

Partial tears can lead to chronic tendonitis but heal naturally

Question 10

What are the symptoms of rotator cuff tear?

Answer 10

Sprain of shoulder

Limited abduction

Question 11

What are the signs of rotator cuff tear?

Answer 11

Tenderness over anterior acromion
Once arm lifted above shoulder it can be held but when lowering arm it will suddenly drop
Intra-articular anaesthetic injection can distinguish between full and partial tear
-partial will regain ability to abduct but full won’t

Question 12

What is the management of rotator cuff tears?

Answer 12

Partial recover in a few weeks

Acute
-heat, exercise, LA injections

After 3wks extent of rupture assessed

Complete tears in young people=surgery

Question 13

What is subacromial bursitis?

Answer 13

Due to repetitive overhead lifting, pulling or trauma

Burning pain
Pain worse on lifting above head
Stiffness when passively abducting arm

Tx
-NSAIDs and avoid exacerbating movement

Question 14

What is painful arc/impingement syndrome?

Answer 14

Pathology leads to swelling and oedema which decreases the space between humeral head and acromion

Painful arc 80-120 degrees

Impingement due to peri-articular pain is less painful on passive movements

Scarf test positive