Makindo Medical Notes

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Bilateral disease suggests a systemic condition such as a spondyloarthropathy. Early diagnosis and appropriate management are essential to prevent chronic pain and functional impairment.

About Painful Shoulder Syndromes

Painful Shoulder Syndromes encompass a range of conditions that cause shoulder pain and dysfunction. These syndromes can result from injuries, overuse, degenerative changes, or inflammatory processes affecting the shoulder joint and its surrounding structures. Understanding the underlying cause is crucial for effective management and treatment.

• Painful shoulder syndromes are common and can significantly impact daily activities and quality of life.
• They may affect individuals of all ages, from athletes to older adults, depending on the underlying cause.

Aetiology

• Rotator Cuff Tear: Overuse or acute injury leading to tendon damage.
• Adhesive Capsulitis (Frozen Shoulder): Inflammation and fibrosis of the shoulder capsule causing stiffness.
• Inflammatory Arthropathy: Conditions like rheumatoid arthritis causing joint inflammation.
• Glenohumeral Osteoarthritis (OA): Degenerative changes in the shoulder joint.

Clinical Presentation

• Shoulder pain that may radiate to the arm or neck.
• Restricted range of motion or stiffness.
• Weakness in the affected arm.
• Swelling or tenderness around the shoulder joint.
• Night pain, particularly when lying on the affected shoulder.

Examination

• Palpation of the shoulder to identify tender areas.
• Assess the contours of the shoulder for asymmetry.
• Palpate from the sternoclavicular joint along the clavicle.
• Examine the acromioclavicular joint up to the acromion.
• Palpate from the humeral head to the acromion for tenderness.

Movements

• Abduction: Assessed to evaluate the supraspinatus muscle function.
• External Rotation: Evaluated to assess the infraspinatus and teres minor muscles.
• Internal Rotation: Tested to assess the subscapularis muscle.

Integrity

• The integrity of the shoulder depends on the muscles, tendons, and ligaments supporting the joint.
• The shoulder joint is shallow and plate-like, relying on surrounding muscles for stability.

Differential Diagnosis

• Rotator Cuff Tear: Differentiated by weakness in specific shoulder movements.
• Adhesive Capsulitis (Frozen Shoulder): Characterized by progressive stiffness and restricted range of motion.
• Inflammatory Arthropathy: Associated with systemic symptoms like joint swelling and morning stiffness.
• Glenohumeral Osteoarthritis: Presents with chronic pain and stiffness, especially in older adults.
• Bursitis: Inflammation of the bursa causing localized pain and tenderness.
• Tendinitis: Inflammation of the tendons leading to localized pain and movement restriction.

Investigations

• Clinical Examination: Detailed physical assessment to identify the specific area of pain and associated functional limitations.
• Imaging Studies:
  • Lateral X-Ray: May show bone spurs or degenerative changes but often not specific.
  • Ultrasound: Useful for detecting tendon tears, inflammation, and bursitis.
  • Magnetic Resonance Imaging (MRI): Provides detailed images of soft tissues, useful for diagnosing rotator cuff tears and other soft tissue injuries.
• Additional Tests:
  • Arthroscopy: Minimally invasive procedure allowing direct visualization of the shoulder joint, useful in complex cases.

Management

• Conservative Treatments:
  • Rest: Reducing activities that exacerbate symptoms to allow healing.
  • Analgesia: Use of pain relievers such as NSAIDs to manage pain and inflammation.
  • Physiotherapy:
    • Stretching and strengthening exercises to restore function and stability.
    • Manual therapy to improve range of motion and reduce stiffness.
    • Modalities like ultrasound or heat therapy to promote healing.
  • Elbow Support: Use of braces or straps to offload stress on the affected tendons.
• Pharmacological Treatments:
  • Steroid Injections: Can provide temporary pain relief and reduce inflammation but may increase the risk of tendon rupture if overused.
• Alternative Therapies:
  • Acupuncture: May help in pain relief and promoting tissue healing.
• Surgical Intervention:
  • Arthroscopic Surgery: Minimally invasive procedure to repair torn tendons, remove bone spurs, or clean the joint.
  • Open Surgery: Reserved for severe cases where arthroscopic methods are insufficient.
• Self-Limiting Nature:
  • Painful shoulder syndromes often resolve once the underlying cause is addressed and the tendon or joint heals.
  • Most patients recover with appropriate treatment within 6-12 months.

Prognosis

The prognosis for painful shoulder syndromes is generally favorable with timely and appropriate management. Most individuals experience significant improvement and eventual resolution of symptoms. However, some cases may become chronic, especially if underlying risk factors are not addressed:

• Early Intervention: Leads to quicker pain relief and restoration of function.
• Chronic Cases: May require more intensive treatments, including surgery, to achieve symptom resolution.
• Recurrence: Preventive measures, such as ergonomic adjustments and strengthening exercises, are essential to minimize the risk of recurrence.

References

• American Academy of Orthopaedic Surgeons. Shoulder Pain. Available at: https://orthoinfo.aaos.org
• Mayo Clinic. Shoulder Pain. Available at: https://www.mayoclinic.org
• Randall, D., et al. (2017). Rotator Cuff Tear. J Orthop Sports Phys Ther.
• Clark, R. A., et al. (2019). Adhesive Capsulitis (Frozen Shoulder). Orthop Clin North Am.
• Sevier, T. L., & Portas, W. A. (2016). Management of Medial Epicondylitis. Curr Rev Musculoskelet Med.
• National Institute for Health and Care Excellence (NICE). Shoulder Pain and Mobility Problems: Assessment and Management. Available at: https://www.nice.org.uk