Makindo Medical Notes

Related Subjects: |Tennis Elbow |Golfer's Elbow |Painful Shoulder syndromes

⚠️ 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 causing shoulder pain and dysfunction. These arise from injuries, overuse, degeneration, or inflammatory processes affecting the joint and periarticular structures. Understanding the underlying cause is crucial for effective treatment.

• 👥 Very common; significantly impact quality of life and activities of daily living.
• 🎾 Occur in all age groups – athletes, manual workers, and older adults with degenerative disease.
• 💤 Night pain is often a key feature, particularly when lying on the affected side.

🧬 Aetiology

• 🪢 Rotator Cuff Tear: Overuse or trauma → tendon damage.
• ❄️ Adhesive Capsulitis (Frozen Shoulder): Capsule fibrosis → severe stiffness.
• 🔥 Inflammatory Arthropathy: e.g. Rheumatoid arthritis → joint inflammation.
• 🦴 Glenohumeral Osteoarthritis: Degenerative cartilage loss.
• 💧 Bursitis: Subacromial bursa inflammation.
• 🎯 Tendinitis: Repetitive strain of rotator cuff tendons.

🩺 Clinical Presentation

• 🩹 Local shoulder pain ± radiation to arm/neck.
• 🚫 Restricted range of motion or stiffness.
• 💪 Weakness in abduction or rotation.
• 🔎 Tenderness or swelling around joint.
• 🌙 Night pain disturbing sleep.

👨‍⚕️ Examination

• 🤲 Palpate sternoclavicular → clavicle → AC joint → acromion → humeral head.
• 👁 Assess symmetry & muscle wasting (supraspinatus fossa).
• 💥 Tenderness localised over cuff or bursa.

🌀 Movements (Key Muscle Tests)

• 🙆 Abduction: Supraspinatus.
• ↩️ External rotation: Infraspinatus + Teres minor.
• ↪️ Internal rotation: Subscapularis.

🏗 Integrity

• 🔒 Stability depends on muscles, tendons, ligaments.
• ⚖️ Shallow glenoid → “golf ball on tee” → relies heavily on rotator cuff for stability.

🧾 Differential Diagnosis

• 🪢 Rotator cuff tear → weakness + painful arc.
• ❄️ Frozen shoulder → progressive stiffness, both active & passive ROM restricted.
• 🔥 Inflammatory arthritis → systemic features, morning stiffness.
• 🦴 OA → older patients, crepitus, reduced ROM.
• 💧 Bursitis → localized tenderness, pain on abduction.
• 🎯 Tendinitis → focal tendon pain, worse with resisted movement.

🔎 Investigations

• 🧑‍⚕️ Clinical exam remains key.
• 📸 X-Ray: May show OA, spurs, calcific tendinitis.
• 📡 Ultrasound: Dynamic, detects tears, bursitis, inflammation.
• 🧲 MRI: Gold standard for soft tissue (rotator cuff tears, labrum).
• 🎥 Arthroscopy: Direct visualization in complex cases.

💊 Management

• Conservative:
  • 🛑 Rest & activity modification.
  • 💊 NSAIDs & analgesia.
  • 👐 Physiotherapy → strengthening, stretching, posture correction.
  • 🌡 Heat/ultrasound therapy.
• Interventional:
  • 💉 Steroid injection → bursitis or frozen shoulder (short-term benefit).
• Alternative: 🌿 Acupuncture, adjunctive role.
• Surgery:
  • 🔪 Arthroscopy → repair tears, debride OA changes, remove spurs.
  • 🩺 Open surgery in severe or failed cases.

📈 Prognosis

• ✅ Most recover with conservative care in 6–12 months.
• ⏳ Frozen shoulder may take 1–3 years to fully resolve.
• ⚠️ Chronic pain possible if risk factors not addressed.
• 🔄 Recurrence prevented by ergonomic advice & strengthening.

📚 References

• AAOS – Shoulder Pain orthoinfo.aaos.org
• Mayo Clinic – Shoulder Pain
• Randall D et al. J Orthop Sports Phys Ther. Rotator Cuff Tear.
• Clark RA et al. Orthop Clin N Am. Frozen Shoulder.
• NICE – Shoulder pain & mobility problems.