Shoulder Problems Flashcards
Which muscles make up the rotator cuff and which movements are they responsible for?
Supraspinatus - initiates abduction
Infraspinatus + teres minor - external rotators
Subscapularis - internal rotator
Which muscle is responsible for abducting the arm?
Deltoid
supraspinatus initiates
What is impingement syndrome of the shoulder?
Painful arc between 60-120 degrees
- tendons of rotator cuff (mainly supraspinatus) are compressed in the subacromial space during movement –> pain
What are some causes of impingement syndrome?
Tendonitis Subacromial bursitis Acromioclavicular OA + inferior osteophyte Hooked acromion Rotator cuff tear
What are the clinical features of impingement syndrome?
Painful arc 60-120 degrees
Pain radiates to deltoid and upper arm
Tenderness below lateral edge of acromion
Hawkins-Kennedy test induces pain
How is impingement syndrome diagnosed?
Clinically
Can be confirmed with MRI
What is the management for impingement syndrome?
NSAIDs, analgesia, physio + subacromial steroid injection (up to 3x)
If no response in 6 months –> subacromial decompression surgery
What is the usual clinical picture in a patient with a rotator cuff tear?
Sudden jerk in a patient > 40 –> pain + weakness
Which muscles are usually affected in a rotator cuff tear?
Usually supraspinatus
Large tears may extend into subscapularis + infraspinatus
What are the examination findings in a rotator cuff tear?
Weakness of initiation of abduction (supraspinatus) +/- internal and external rotation
Which tests can be done to identify tears in specific rotator cuff muscles?
Jobe’s test –> supraspinatus (weakness)
Gerber’s test –> subscapularis
Posterior cuff test –> infraspinatus + teres minor
How is a rotator cuff tear diagnosed?
USS or MRI
What are the management options for rotator cuff tear?
Conservative first line:
- analgesia, physio +/- steroid injection
Surgery - rotator cuff repair
- tends to fail because tears usually occur in diseased (degenerative) tendons
What is another name for frozen shoulder?
Adhesive capsulitis
Which age group tend to get frozen shoulder?
40-60 years old
What is the usually clinical course in frozen shoulder?
Initially pain predominates
Then becomes very stiff
Gradually ‘thaws’
Resolves after about 18-24 months
Which conditions are associated with frozen shoulder?
Diabetes
Hyperlipidaemia
Dupuytren’s disease
How is frozen shoulder diagnosed?
Clinically
What is the management for frozen shoulder?
Physiotherapy, keep exercising
Paracetamol + NSAIDs
Steroid injection/oral steroids if failing to improve
If still no better –> manipulation under anaesthetic or surgical capsular release
What is acute calcific tendonitis?
Acute severe shoulder pain due to calcium deposits in supraspinatus tendon
How is acute calcific tendonitis diagnosed?
Xray –> calcium deposits seen just proximal to greater tuberosity
What are the clinical features of biceps tendonitis?
Inflammation of tendon of long head of biceps –>
- anterior shoulder pain
- pain on resisted biceps contraction
- tendon can rupture –> bunched up muscle ‘Popeye deformity)
What is the management of biceps tendonitis?
Analgesia, ice therapy, physio
US guided steroid injections
Which structures may cause referred pain in the shoulder?
Neck
Cardiac
Diaphragmatic irritation
