Shoulder Trauma - Adhesive capsulitis, Rotator cuff, Shoulder dislocation

Question 1

Adhesive capsulitis
-associations
-pathophysiology
-presentation
-investigations
-management

Answer 1

DM
Middle age women

Inflammed GHJ ligaments => scar tissue limiting movement
Scar tissue eventually breaks down and replaced by healthy flexible ligaments

Limited range of movement, esp EXT ROT
Extremely painful
Lasts 6months-2years

Clinical diagnosis

No single intervention has been shown to improve outcome s in long term
-NSAIDs, physio, PO CS, IA CS

Question 2

Rotator cuff injury
-affected muscles
-types of injuries
-presentation
-investigations
-management

Answer 2

Supraspinatus (most vulnerable), infraspinatus, subscapularis, teres minor

Subacromial impingement - inflammed supraspinatus cannot pass under subacromial space => pain
Calcific tendonitis - calcum formation within tendons
Rotator cuff tears
Rotator cuff arthropathy - wear and tear arthropathy of shoulder

Pain worse on abduction
Tender in anterior acromion
Painful arc test
-subacromial impingement - 60-120deg
-rotator cuff - 1st 60degs

US/MRI to confirm diagnosis

Rest, analgesia (paracetamol/PO NSAID/CS injection)
If pain+function loss or sudden lost ability to raise arm => 2ndary care referral

Question 3

Shoulder dislocation
-pathophysiology
-associations

Answer 3

Humeral head dislodges from glenoid cavity
-past rotator cuff tears, GHJ ligament damage

SIGNIFICANT SHOULDER PAIN
INABILITY TO MOVE SHOULDER
Axillary nerve damage - regimental badge numb, weak deltoid abduction

AP, Y view
Check NVS

Anterior dislocation - high energy collisions, falls
-ABD EXT ROT
Antero-inferior humeral head
Out of line from Y

Posterior dislocation - force onto anterior shoulder surface
-epilepsy, electrocution, TOH
-ADD INT ROT
Lightbulb sign

Reduction, followed by post-reduction Xray
Surgical referral if unsuccessful