Shoulder pain

55 Shoulder pain





Questions



image What are the joints of the shoulder and the muscles of the rotator cuff?

image What are the causes of a painful arc syndrome?

image What are the other causes of shoulder pain?

Shoulder pain is the second most common cause of orthopaedic pain presentating to a general practitioner. The shoulder is composed of two bones (humerus and scapula) and three joints (glenohumeral, scapulothoracic and acromioclavicular). The rotator cuff is composed of four muscles, which reinforce the capsule and provide active support during movement (SITS: supraspinatus, infraspinatus, teres minor, subscapularis).


The glenohumeral joint is a ball and socket joint, where stability is sacrificed to allow a wide range of movement. It is a shallow joint and, although stability is improved by the glenoid labrum, joint capsule and rotator cuff muscle, it is relatively unstable compared with the hip.




Diagnosing shoulder disorders


For most disorders, diagnosis is based on the clinical features, with imaging playing a role in some. Plain radiograph (showing calcification, abnormal anatomy, joint spaces), ultrasound (cheap, can detect soft tissue damage, can guide needle-based treatments) and MRI (non-invasive, extremely sensitive and specific) are available. Shoulder arthroscopy has become increasingly used and is both diagnostic and therapeutic.



Common causes of shoulder pain



Painful arc syndrome


Pain occurs upon mid-range of active abduction (60–120°; Fig. 3.55.1) when a tendon structure (nodule) becomes painfully impinged within the subacromial space. Passive abduction is complete and painless. There are five causes.


image

Fig. 3.55.1 Painful arc syndrome pain.



Supraspinatus tendonitis


Acute inflammation of the supraspinatus muscle causes an acute area of swelling, which becomes painfully squashed underneath the acromion during abduction. The muscle eventually clears the nodule and pain disappears. Treatment is with rest, NSAIDs, and injection of steroid with local anaesthetic.

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Shoulder pain

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