Shoulder pain Flashcards
(25 cards)
Muscles in rotator cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Supraspinatus: movement and innervation
Abducts
Suprascapular nerve
Infraspinatus: movement and innervation
External rotation
Suprascapular nerve
Teres minor: movement and innervation
External rotation
Axillary nerve
Subscapularis: movement and innervation
Internal rotation
Upper and lower subscapular nerve
Stages of tendon self-repair(3)
Inflammation Proliferation - newly formed type III collage Remodelling - type III replaced with type I
Tendonitis pathophysiology
Microtears due to acute overloading
Inflammation
Tendonopathy pathophysiology
Degenerative process due to chronic overloading
No inflammation
Rotator cuff tear, presentation
Pain, reduced movement
Glenoid head not held in socket
Rotator cuff tear, management
Conservative - analgesia, physiotherapy
Injection - steroid and LA into subacromial space
Surgical intervention
Steroid injection factors to remember
Anticoagulation
Diabetes (might inc sugars, higher risk of infection)
Systemically well
Allergies
Steroid injection risks
Fails to work Infection Pain Temporary worsening of symptoms Bruising, bleeding
Types of surgical intervention for rotator cuff tear
Repair tear
- sutures and bone anchors, reattach cuff to greater tuberosity
Subacromial decompression
- helps with above
- remove inflamed tissue, creates space for gliding
Arthroplasty
- if also arthritis
Differentials for shoulder pain
OA RA Referred pain from neck Rotator cuff tear Frozen shoulder Subacromial impingement syndrome Bursitis
Frozen shoulder, pathophysiology
“Adhesive capsulitis”
Capsule thick and tight, can’t move
Bands of scar tissue
Less synovial fluid
Frozen shoulder, three phases
Freezing phase
Frozen phase
Thawing phase
Frozen shoulder: Freezing phase
Pain on movement, worsens
6-9 months
Movement limited
Frozen shoulder: Frozen phase
Pain may get better
More stiffness
4-12 months
Frozen shoulder: Thawing phase
Range of motion starts to return to normal
6 months to 2 years
Frozen shoulder management
Basic pain relief (paracetamol, ibuprofen)
Stronger painkillers
Steroid injections
Physiotherapy
Subacromial impingement syndrome (SAIS) definition
Inflammation and impingement of rotator cuff tendons as they pass through the subacromial space
SAIS features
Pain, worse on lifting arm above head
Weakness
Reduced ROM
Types of injury in SAIS
Tendonitis Bursitis Calcific tendonitis Tendonopathy Tears (partial or complete)
Management of SAIS
Painkillers Heat/ice Exercises Steroid injections Surgical intervention - subacromial decompression
