SHOULDER INJURIES DR MARK RIDGEWELL 27/7/2010

Infraspinatus

Supraspinatus

75% of cases of shoulder pain due to supraspinatus Weakest point of tendon 1cm form insertion into humerus Can have tendinopathy, partial or complete tears Symptoms: impingement

Labrum

Instability Traumatic dislocation – Trauma enough to pull humerus out of its socket – If labrum is pulled off bone –Bankart lesion

Impingement Sub-acromial Younger patient – traction overload, overuse Older patient – tears more common, trauma

Clinical Features Intense pain C5 distribution Night pain Painful arc Tenderness at greater tuberosity “Empty can sign” May co-exist with gleno-humeral instability

Shoulder Examination – Distinguishing Features A-C joint – tenderness localised; +ve scarf test; painful arc >90 degrees Subacromial bursitis – painful arc mid-range, tender over bursa, +ve impingement tests Biceps tendinopathy – pain on resisted elbow supination/flexion Shoulder capsulitis – gross restriction active and passive movements

Shoulder Examination – Distinguishing Features weakness resisted rotator cuff tests – suggests tear

Subacromial Bursa - Posterolateral Approach Landmarks: Posterolateral border acromion; aim upwards and slightly medially Position: Arm hanging by side to distract humerus from acromion Needle : green Steroid : 20mg LA: 4-5mls total volume