Shoulder Problems

Question 1

Presentation of frozen shoulder/adhesive capsulitis

Answer 1

• Progressive reduction in active and passive ROM
  
  • Reduced external rotation (<30^o)
  • Reduced abduction (<90^o)
• Shoulder pain - especially at night
• Commonly associated with DM

Question 2

Management of frozen shoulder/adhesive capsulitis

Answer 2

• Conservative
  
  • Rest
  • PT
• Medical
  
  • NSAIDs
  • Subacromial bursa steroid +/- LA injection

Question 3

Pathology of shoulder impingement

Answer 3

• Entrapment of supraspinatus tendon and subacromial bursa between aromion and greater tuberosity of humerus
• Subacromial bursitis and/or supraspinatous tendonitis

Question 4

Presentation of shoulder impingement

Answer 4

• Painful arc (60-120^o)
• Weakness and reduced ROM
• Positive Hawkin’s test

Question 5

Investigation and management of shoulder impingement

Answer 5

• X-ray may show bony spurs
• US or MRI arthrogram
• Conservative
  
  • Rest
  • PT
• Medical
  
  • NSAIDs
  • Subacromial bursa steroid +/- LA injection
• Surgical
  
  • Arthroscopic acromioplasty

Question 6

Rotator cuff muscles

Answer 6

• Subscapularis
• Teres minor
• Supraspinatus
• Infraspinatus

Question 7

Rotator cuff tears

Answer 7

• Secondry degeneration or sudden jolt/fall
• Partial tears lead to a painful arc
• Complete tears lead to shoulder tip pain, full range of passive movement, inability to abduct the arm, active abduction possible following passive abduction to 90^o and lowering arm beneath this causes sudden drop
• Requires open or arthrowscopic repair