{"id":412,"date":"2017-03-26T14:07:10","date_gmt":"2017-03-26T14:07:10","guid":{"rendered":"http:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/shoulder-pain\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"shoulder-pain","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/shoulder-pain\/","title":{"rendered":"Shoulder pain"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags &#8211; night pain, wt loss, fever, numbness, PMH malignancy,<\/li>\n<li>Others &#8211; neck pain, right handed, cancer, occupation, trauma, impact<\/li>\n<li>Examine &#8211; shoulder\/neck<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Xray<\/li>\n<li>USS<\/li>\n<\/ul>\n<\/li>\n<li>Acromioclavicular joint\n<ul>\n<li>Younger patient, manual worker, sportsman, pain on top of shoulder, painful to lie on that side, tender over ACJ<\/li>\n<li>Tx: activity modification, NSAIDs, physiotherapy, steroid injection, surgery<\/li>\n<\/ul>\n<\/li>\n<li>Subacromial space\n<ul>\n<li>Subacromial bursa<\/li>\n<li>Rotator cuff\n<ul>\n<li>Rotator cuff tendinopathy\n<ul>\n<li>often caused by repetitive movements &#8211; painful arc, dull throbbing over deltoid, impingement signs (positive Hawkin&#8217;s test)<\/li>\n<li>Tx: activity modification, NSAIDs, steroid injections, physiotherapy, surgery<\/li>\n<\/ul>\n<\/li>\n<li>Rotator cuff tear\n<ul>\n<li>Tear usually due to trauma, &gt;40yo &#8211; pain and weakness in shoulder &#8211; unable to raise arm over head<\/li>\n<li>Tx: NSAIDs, rest, orthopaedic referral if acute tear<\/li>\n<\/ul>\n<\/li>\n<li>Acute calcific tendonitis\n<ul>\n<li>crescendo severe pain<\/li>\n<li>Tx: Xray, steroid injection, surgery<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Gleno-Humeral joint\n<ul>\n<li>Capsule (Adhesive capsulitis i.e. frozen shoulder)\n<ul>\n<li>40+yo, diabetes &#8211; three phases: (1) pain (2) pain + stiffness (3) gradual improvement. Marked reduction in external rotation &#8211; inflammation of surrounding tissues making them stiff<\/li>\n<li>Tx: usually resolves over 18-24 months, analgesia, steroid injection, physiotherapy, surgery<\/li>\n<\/ul>\n<\/li>\n<li>Osteoarthritits\n<ul>\n<li>wear and tear of joint &#8211; older age, gradual onset of pain, reduced ROM, crepitus<\/li>\n<li>tx: Xray, analgesia, steroid injection, physiotherapy, surgery<\/li>\n<\/ul>\n<\/li>\n<li>Labral injuries (instability)\n<ul>\n<li>traumatic &#8211; younger patient following dislocation<\/li>\n<li>capsular laxity &#8211; hypermobility, check Beighton score<\/li>\n<li>Ix: Apprehension test<\/li>\n<li>Tx: surgery (if young), physiotherapy (if hypermobility)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Notes<\/h4>\n<ul>\n<li>Shoulder exercises examples\n<ul>\n<li>pendulum swing, door press<\/li>\n<\/ul>\n<\/li>\n<li>Xray shoulder\n<ul>\n<li>OA<\/li>\n<li>Calcific tendonitis<\/li>\n<\/ul>\n<\/li>\n<li>USS shoulder\n<ul>\n<li>Good for full thickness tears, calcific tendonitis<\/li>\n<li>Cant diagnose impingement<\/li>\n<li>Can be wrong<\/li>\n<\/ul>\n<\/li>\n<li>Special tests on examination\n<ul>\n<li>\u00a0Supraspinatus\n<ul>\n<li>Empty beer can test<\/li>\n<\/ul>\n<\/li>\n<li>Infraspinatus\n<ul>\n<li>Weak external rotation (elbow tucked in)<\/li>\n<\/ul>\n<\/li>\n<li>Subscapularis\n<ul>\n<li>Napoleon&#8217;s Belly press (hand on belly, move elbow forward)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags &#8211; night pain, wt loss, fever, numbness, PMH malignancy, Others &#8211; neck pain, right handed, cancer, occupation, trauma, impact Examine &#8211; shoulder\/neck &nbsp; Clinical management Investigations Xray USS Acromioclavicular joint Younger patient, manual worker, sportsman, pain on top of shoulder, painful to lie on that side, tender over ACJ Tx: activity &hellip; <a href=\"https:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/shoulder-pain\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Shoulder pain<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":408,"menu_order":168,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-412","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/412","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=412"}],"version-history":[{"count":10,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/412\/revisions"}],"predecessor-version":[{"id":2029,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/412\/revisions\/2029"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/408"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=412"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}