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Shoulder

Definitions​

  • Rotator Cuff Disease - tendinopathy or tear of >= 1 of the 4 rotator cuff muscles, or subacromial bursitis - the most common cause of shoulder pain presenting to physicians
  • Subacromial Impingement Syndrome - clinical entity characterised by a 'painful arc' of shoulder abduction between 60 and 120 degrees; can be caused by rotator cuff disease

Anatomy​

  • supraspinatus muscle initiates abduction
  • infraspinatus initiates external rotation
  • teres minor initiates external rotation and some adduction
  • subscapularis initiates adduction and internal rotation

Differential​

  • referred pain from the c-spine
  • osteoarthritis
  • adhesive capsulitis (frozen shoulder)

Clinical Presentation​

  • Dull pain which becomes sharp and throbbing with overhead activities

  • Localised in the deltoid muscle

  • Night pain, weakness, stiffness, crepitus

  • Muscle atrophy on examination

  • Pain on passive movement suggests adhesive capsulitis (frozen shoulder) or glenohumeral arthritis

Prognosis​

  • Most improve with conservative, non-operative management
  • Large tears can progress and become irreparable

Reference​

📄 JAMA - Does This Patient With Shoulder Pain Have Rotator Cuff Disease?

  • TODO Finish notes from JAMA Article
  • TODO Add information from NICE CKS