Please enable JavaScript.
Coggle requires JavaScript to display documents.
SHOULDER CONDITIONS (OTHERS (Biomechanical (Cervical Suprascapular…
SHOULDER CONDITIONS
IMPINGEMENT
AC Jt from overhead work, pain from 60-120 of ABduction
Subacromial
3 Developmental Stages
1st stage: moderate pain during exercise
2nd stage: pain during ADL esp night, loss mobility
3rd stage: strong movement restriction due to calcification, loss mm strength
Epidemiology
Anatomical variations: narrow SA space, type 2/3, osteophytes
Rotator cuff weakness, overuse
Posterior GH capsule tightness
Poor posture, abnormal mm activation
TOS
ROTATOR CUFF & BICEPS
Tendinopathy / Tendinitis
Supraspinatus
Causes
Trauma, Overuse, Degenerated tendon with decreased vascularity
Bicipital
teno-synovitis of biceps long head
Causes
transverse humeral lig ruptured, tendon slide back forth, wear tear -> tendon inflammation, rigid & narrow of bicipital groove, repeated overhead activities
Infraspinatus
Caused by
throwing
stressing capsule & ligs of GH Jt
Felt at
outer aspect around deltoid
, Night sharp pain associated with movement
Bursitis
Subacromial
Tears usually > 45yo
Night sharp pain from lying on affected side
Causes
degenerative changes, repetitive microtrauma, severe traumatic injuries e.g. fall on out-stretched arm, unexpected pulling / pushing forces
Constant aching due to chronic tear of rotator cuff
Rupture
Supraspinatus
Long head of Biceps Tendon
Sudden snap at anterior shoulder
Infraspinatus
Causes
Degeneration at musculotendinous junction
Calcific Tendinitis
Locations
Supraspinatus tendon
hydroxyapatite deposition disease (HADD)
Infraspinatus tendon
Subscapularis tendon
Causes
Hypovascularisation, Compression, Metabolic, Mesodermal defects, local degenerative
SLAP LESION
4 Types
Type I
degeneration, no detachment o biceps insertion
Type II
detachment of superior labrum & biceps from glenoid rim
Type V Bankart Lesion
extends superiorly
Type VI
unstable flap tear of labrum, biceps tendon separation
Type VII
superior labrum + biceps tendon separation that extends anteriorly
Type III
labrum tear, intact biceps tendon to bone
Type IV
intra-substance tear of biceps tendon & superior labrum
2 Mechanisms of Injury
Direct blow to shoulder at fall
Superior Compression
by repetitive superior translation of humeral head on glenoid rim
Inferior Traction
from sudden traumatic inferior pull on arm, overhead sports
ADHESIVE CAPSULITIS (FROZEN SHOULDER)
Scapula, Clavicle
Primary
Cause
Idiopathic
Secondary
Cause
known cause, surgical event
3 Categories
Systemic
e.g. diabetes mellitus
Extrinsic
e.g. cardiopulmonary dx, cervical disc, CVA, humerus fractures, Parkinson's
Intrinsic
e.g. rotator cuff pathologies, biceps / calcific
tendonitis, AC jt arthritis
Intense constant aching in deep shoulder, night pain, > 35yo, global loss of AROM and PROM
Progress through
3 Phases
Acute / Freezing / Painful
Phase: gradual onset of pain at rest, sharp pain at extreme motion, night pain, lasts
3-9 mths
Adhesive / Frozen / Stiffening
Phase: pain subsiding, progressive loss of GH motion in capsular pattern, pain only at extreme movements
4-12 mths
Resolution / Thawing
Phase: progressive improvement in functional ROM,
1-3.5 yrs
Ddx
OA
: PROM not limited
Bursitis
has severe pain in most motions, has large PROM
Rotator Cuff Pathologies
not restricted by ROM
Posterior Dislocation
not able to fully supinate arm while flexing shoulder
Outcome Measures
SPADI, DASH, ASES, SST, PSS, NPRS, VAS, SF-36
GLENOHUMERAL
Osteoarthritis
Instability / Hypermobility
Arthrosis
Avascular humeral head
POLYMYALGIA RHEUMATIC
> 60yo
Bilateral shoulder pain in morning
Higher ESR
OTHERS
Fractures
Biomechanical
Atraumatic instability
Dislocations
Cervical Suprascapular
Paraesthesia
TOS
Radiate pain to arm
Brachial Neuritis
CRPS
Tumour
Pancoast Tumour of lung apex
Infection
Septic arthritis
Osteomyelitis
Inflammatory Arthropathies
Rheumatoid arthritis
Gout
Cervical arthritis
Myocardial Ischarmic (left shoulder pain)
Visceral
Visceral organs innervated by Phrenic N. C3, 4, 5
Gall bladder disease
Diaphragmatic irritation
HYPERMOBILITY
Causes
genetic, Marfan syndrome, osteogenesis, imperfecta
Beighton hypermobility score
Outcome Measures
DASH, Quick DASH, PSS, GRCS, CMS, RC-QOL, FSET, SPADI, ASES, UCLA, SST
Referred Shoulder Pain
Spinal origin, Myofascial, Visceral