Common Shoulder Problems in Primary Care

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Common Shoulder Problems in Primary Care

• Diagnosis and management
• 9th October 2008

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Anatomy Review

• Shoulder Girdle

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Shoulder R lateral view
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Shoulder R post view
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Rotator Cuff Muscles
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Shoulder Movements

• Active Range of Motion (ROM)
• Flexion _at_ 180o
• Extension _at_ 50o
• Abduction _at_ 180o
• Adduction _at_ 40o
• Internal Rotation _at_ 90o
• External Rotation _at_ 90o

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Shoulder Diagnoses

• Impingement
• Capsulitis (Frozen Shoulder)
• 3. Rotator Cuff Tear
• 4. Arthrosis (AC GH)
• 5. Instability

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History Where?

• Neck/shoulder sweep ? Cervical
• Superior (well localised) ? AC joint
• Deltoid ? SA/GH

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Impingement

• aka Supraspinatus Tendinitis, Rotator Cuff
  syndrome, Subacromial Bursitis etc.
• Middle aged
• Pain in deltoid area
• Painful arc, impingement sign
• Pain on resisted cuff tests

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Subacromial Impingement
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Shoulder Examination
Hawkins Test
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Frozen Shoulder

• Middle aged (40-60 years)
• Pain in deltoid area (C5 dermatome)
• Active and passive movements restricted
• Minimal passive lateral rotation

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Rotator Cuff Tear

• Extreme form of impingement
• Very painful and weak
• Suspect it if sudden or traumatic onset, gt60
  years or no response to two
• sub-acromial injections
• Get a scan (USS)
• Refer to a shoulder surgeon ??

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A-C joint

• Sports person (sprain) or the elderly (OA)
• Well localised pain
• Point to the joint
• Scarf test and tender over the joint

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The Neck

• Pain in the neck
• Pain in the scapular region
• Neck movements aggravate the pain
• Often asymmetrical pain pattern
• Full painless shoulder forward flexion
• Mechanical neck pain is managed like mechanical
  low back pain

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Spurlings Test
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Impingement Management

• Patient Information Leaflet
• Analgesia
• Injection - 20-40mg Kenalog 5ml 1 lidocaine.
  (Inject posteriorly under acromion)
• Physiotherapy
• Surgery (SAD)

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Capsulitis Management

• No X-ray
• Patient Information leaflet
• Analgesia
• Injection (1 ml Kenalog, up to 10 ml 0.25
  Marcain)
• Physiotherapy
• Surgery

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AC joint OA Management

• ? X-ray
• Analgesia
• Injection difficult. Orange needle.
  Fingerbreadth in from lateral acromion. 10mg
  Kenalog 0.75ml 1 lidocaine
• Surgery

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Summary

• Remember the Neck
• 3 common conditions in Primary Care
• - Impingement
• - Capsulitis
• - A-C joint OA
• Pts lt 35yo refer if pain perists