SHOULDER PAIN
Anatomy 1. Superficial layer Deltoid muscle Pectoralis major and minor muscles Trapezius muscle 2. Subdeltoid bursa
Anatomy 3. Rotator cuff Supraspinatus Infraspinatus Teres minor Subscapularis
Anatomy 4. Ligamentous capsule and Joint space
Shoulder Pain 1. Periarticular Structures 2. Glenohumeral joint 3. Distal Sites
Diagnostic Approach Most Common Causes of Shoulder Pain in Adults Rotator cuff tendinitis Rotator cuff tears Subdeltoid/subacromial bursitis Adhesive capsulitis/frozen shoulder
History 1. Perceived location ? 2. History of recent trauma ? 3. What precipitates the pain ? 4. History of occupational and sport activities ?
Physical Examination 1. Active ROM 2. Passive ROM 3. Resisted Movements 4. Palpation
Physical Examination Internal rotationExternal rotation
Physical Examination Impingement Test
Physical Examination External Rotator Cuff Strength Internal Rotator Cuff Strength
Interpretation of Physical Examination active ROM + passive ROM arthritis, capsulitis, bursitis lateral rotation arthritis/capsulitis abduction bursitis active ROM + normal passive ROM rotator cuff lesions
Additional Diagnostic Tests Shoulder X-ray – trauma, suspected arthritis, chronic unexplained pain CT/MRI shoulder – evaluations of soft tissue lesions Ultrasonography of shoulder – rotator cuff tears Arthrography - rotator cuff tears, soft tissue lesions
Anterior Shoulder Dislocation
Posterior Shoulder Dislocation
Management strategies 1. Physical Therapy/Physical Activity Acute - brief period (2-3 days) of rest with the arm in sling ROM movements immediately to maintain mobility Avoid aggressive exercise or prolonged immobilization
Management strategies 1. Physical Therapy/Physical Activity 2. Medication NSAIDs/Acetaminophen 2-week course
Management strategies 1. Physical Therapy/Physical Activity 2. Medication 3. Injection therapy Contraindications: overlying soft tissue infections, septic joint, clotting disorder Avoid heavy arm use for several weeks after injection Serious complications are rare (< 1%)