Page 138 - ASOP ROT Study Guide

Tdihsecofomllfoowrti:ng structures commonly are involved in pathological conditions causing shoulder

♦ the subacromial bursa
♦ the supraspinatus tendon
♦ the acromioclavicular joint
♦ the biceps tendon
♦ the rotator cuff as a whole

Unfortunately it may difficult or impossible to localize which of these structures gives rise to the
symptoms. Fortunately most of the minor conditions settle with rest and time. To resolve the
differential diagnosis may require specialist examination including arthrography or arthroscopy.

15 . 3 Management

If rest, gentle exercise and anti-inflammatory drugs do not help, a careful examination may reveal a
point of tenderness. Tenderness under active movement within a painful arc is suggestive of a
supraspinatus tendon inflammation or a subacromial bursitis. A steroid injection into the bursa or
around the tendon, but not into it, can be very effective. Whether this is reasonable or not (and this
remains controversial), it certainly should only be done with care.

Occasionally the sufferer may have very severe pain and a radiograph will show calcified material
within the supraspinatus tendon. Injection or even surgery to remove the calcified material in this
case is well justified for the pain relief achieved.

Unfortunately many people only respond temporarily to the injection. Further investigation often
shows degenerative change, and osteophytes in the acromioclavicular joint. This may lead to
rupture of the supraspinatus muscle which is part of the rotator cuff (see Skeletal Anatomy and
Physiology module Unit 2b). Such rotator cuff tears can become large rents and even small ones
cause a lot of discomfort and pain. Surgery to relieve the cause and repair the rotator cuff, will
bring effective pain relief and some return of function. Repetitive injections in such patients can
result in further degeneration of the rotator cuff and should not be practiced.

15 . 4 Frozen Shoulder

This is a poor term and is a very rare condition. Most so called "frozen shoulders" are sore
shoulders caused by one of the conditions outlined above. Frozen shoulder is a condition in which
there is little or no gleno-humeral movement. It occurs rarely, in those who have had a specific
trauma incident, such as an epileptic fit or an electric shock. Often the cause is obscure.' Such
people eventually recover in eighteen months to two years. They require a lot of psychological
support and physiotherapy. The condition may be helped by manipulation under anesthetic.