Motor physical examination of the shoulder
http://www.youtube.com/watch?v=VSrLbzZzJU8
Source from University of Wisconsin, Department of Family Medicine
STANDARD PROCEDURE OF JOINT EXAMINATIONS
The patient’s shoulders must be exposed for the examination and the affected side must be compared with the unaffected side.
1) Inspection
a. Inspect for gross abnormalities or deformities including evidence of trauma
b. Swelling of the AC joint, erythema, warmth,
c. Asymmetry of both shoulders,
d. Muscle atrophy especially of the supraspinatus, infraspinatus and deltoid muscles
2) Palpation
a. Begin from the SC joint, note any tenderness, palpate the clavicle laterally to the AC joint (soft spot to the distal end of the clavicle)
b. Move over the AC joint and palpate the subacromial bursa
c. Move anteriorly and laterally to the bicipital groove (intertubercular groove), if difficult to locate, externally rotate the humerus and palpating the anterior superior portion of the humeral head and feel the tendon move
d. Medial to the groove is the lesser tuberosity and laterally would be the greater tuberosity
e. Palpate the spine of the scapula and the supraspinatus and infraspinatus muscles
3) Range of motion
a. Ask patient to move both of the arms together
b. If pain limits the movement, then passively assist the patient
c. Useful to ask patient to mimic your own movements
d. First ask patient to lift both arm in front of them to 180 degrees
e. Next ask to extend arm behind back, should be able to reach approximately 40 degrees
f. With hands supinated, move arms in an arc movement, 180 degrees (should be painless) (Abduction)
g. Reverse the motion back to point of start (Adduction)
h. External rotation can be tested with the arms flexed at 90 degrees, ask patient to rotate the arms outwards, approximately 60 degrees is normal
i. Internal rotation can be tested next
j. Ask patient to reach to the neck region, hand should be able to reach the superior medial aspect of the opposite scapula, or just take note of the corresponding vertebrae level (index finger)
k. Reach both hand up back, note vertebrae level, should be able to reach the inferior angle of the scapula, T7 level
4) Strength test (All muscle testing should be graded with the 5 point scale and compared to the other side)
a. Stand to the side and slightly behind the patient, place hand on the shoulder to provide support for the patient, grasp arm with other hand
b. Ask for flexion of elbow and bring arm forward to test the strength of flexion
c. Next push back to you to test strength of extension
d. Ask patient to again flex both arms to test external and internal rotation strength (outward rotation is to test teres minor and infraspinatus, inward rotation test the subscapularis)
e. To test the supraspinatus perform the Jobes test, bring patient’s arm to 90 degrees of abduction and move arms forward by 30 degrees, point thumbs down to the floor like dumping out contents of cans and then ask patient to push up against your hands
f. Test subscapularis with the lift off test, ask patient to put hand with palm facing outwards at the lower back, place your palm with the patient’s palm to offer resistance and ask patient to push his/her hand away from his/her body
5) Special tests
a. Test integrity of the rotator cuff, impingement problems, problems of biceps tendons, labrum tears and shoulder instability
b. Do a drop arm test to test for a rotator cuff tear, specifically the supraspinatus. With palms supinated, ask patient to bring arms to the top (abduction) and slowly bring it down to 90 degrees, if there is a tear the arm would drop and not be able to hold the 90 degree position
c. An impingement test would require you to again stabilize the patient’s scapula and prone her hands. Passively lift the patient’s arms as high as possible, a positive test would be reported as pain by the patient as this moves the rotator cuff muscles under the coraco-acromial arch
d. The Hodkin’s test, flex patient’s arm to 90 degrees, flex elbow and forcibly internally rotate the arm, this moves the greater tuberosity under the coraco-acromial arch impinging the supraspinatus tendon
e. Speed’s test is performed with the arm supinated and raised to shoulder level in front of the patient. Press down and ask patient to resist. This test indicates bicep tendon or labrum pathology.
f. A more sensitive test for labral tear is the O’Brian’s test. Forward flex the patient’s to 90 degrees, adduct about 20 degrees and internally rotate the hand so that thumb faces down, ask patient to resist the downward pressure. Next externally rotate the arm and again ask them to resist the downward pressure. A positive test would be pain or painful clicking when the thumb is down but resolved when the thumb is up.
g. Crank test for labral pathology. Forward flex to 90 degrees, flex elbow. Apply force to the axial while internally and externally rotating the arm. A positive test is pain or painful clicking
h. Last test is for glenohumeral stability. The apprehension test could be done with the patient sitting or standing. Stabilize the scapula. Move to 90 degrees of abduction and externally rotate the humerus. A positive test is a look of apprehension on the patient’s face.
i. The test could be performed with the patient lying down. The relocation test is to apply pressure to the posterior on the proximal humerus and looking at the sense of relieve. The anterior release test for anterior shoulder instability could be shown by a patient’s report of instability or pain after release of the pressure.
Friday, July 30, 2010
A brief reminder- PCL 4
Hey G guys and gals!
Just wanna remind you that the due date for submission is midnight Saturday (31st July). I will then send an email to Dr Amudha with the compiled version on Sunday. Also, we shall have a meeting on Monday in Week 4 before the PCL session to organize our materials. Thanks for your cooperation!
PCL 4 - Types of Joints
If there are images in this attachment, they will not be displayed. Download the original attachment
Joints
A joint is a location at which two or more bones make contact.
They are constructed to allow movement and provide mechanical support
Joints
Pivot joints
Hinge joints
Gliding joints
Ball and Socket joints
Saddle joints
Condyloid joints
Types of joints
Allow rotation around an axis
Allows rotation of one bone around another
In the neck, the occipital bone spins over the top of the axis
Pivot joint
Allows movement only in one plane
Allows flexion and extension
Present at the elbow
Hinge Joint
Allows bones to slide across one another in the plane of its articular surfaces
Midcarpal and Midtarsal joints are gliding joints
Gliding Joints
Most maneuverable type of joint
Allows flexion, extension, adduction, abduction, internal and external rotation
Found in both the shoulders and the hips
Ball and Socket Joints
Allows flexion, extension, adduction, abduction and circumduction
Biaxial where they allow movement in the sagittal and frontal planes
Found on the joint of the thumb
Saddle Joints
Also known as ellipsoid joint
Permits movement in 2 planes as well
Same movements as saddle joint which are flexion, extension, adduction, abduction and circumduction
Found at the wrists
Sorry this is brief its just a copy paste of the powerpoint. there will be picture on monday =)
Joints
A joint is a location at which two or more bones make contact.
They are constructed to allow movement and provide mechanical support
Joints
Pivot joints
Hinge joints
Gliding joints
Ball and Socket joints
Saddle joints
Condyloid joints
Types of joints
Allow rotation around an axis
Allows rotation of one bone around another
In the neck, the occipital bone spins over the top of the axis
Pivot joint
Allows movement only in one plane
Allows flexion and extension
Present at the elbow
Hinge Joint
Allows bones to slide across one another in the plane of its articular surfaces
Midcarpal and Midtarsal joints are gliding joints
Gliding Joints
Most maneuverable type of joint
Allows flexion, extension, adduction, abduction, internal and external rotation
Found in both the shoulders and the hips
Ball and Socket Joints
Allows flexion, extension, adduction, abduction and circumduction
Biaxial where they allow movement in the sagittal and frontal planes
Found on the joint of the thumb
Saddle Joints
Also known as ellipsoid joint
Permits movement in 2 planes as well
Same movements as saddle joint which are flexion, extension, adduction, abduction and circumduction
Found at the wrists
Sorry this is brief its just a copy paste of the powerpoint. there will be picture on monday =)
Thursday, July 29, 2010
PCL 4 - Differential Diagnosis for Rotator Cuff Tendinopathy
Labrum Tear
The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.
Signs and Symptoms:
Depends on where the tear is located, but may include:
· An aching sensation in the shoulder joint
· Catching of the shoulder with movement
· Pain with specific activities, occasional night pain
· Popping, locking or grinding
· Decreased range of motion
· Sense of instability in shoulder
· Loss of strength
In addition, some types of labral tears, specifically a Bankart lesion, can increase the potential for shoulder dislocations.
SLAP tear
A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.
A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.
How does a SLAP tear occur?
Common reasons for a SLAP tear include:
◦ Fall onto an outstretched hand
◦ Repetitive overhead actions (throwing)
◦ Lifting a heavy object
The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.
Signs and Symptoms
· catching sensation and pain with shoulder movements, most often overhead activities such as throwing.
· pain deep within the shoulder or in the back of the shoulder joint.
· SLAP tears with associated biceps tendonitis, patients may complain of pain over the front of the shoulder.
Diagnosis of SLAP tear
· shoulder physical examination.
· History taking
· SLAP tears tend to be seen best on MRI when the study is performed with an injection of contrast. A contrast MRI is performed by injecting a fluid called gadolinium into the shoulder; the gadolinium helps to highlight tears of normal structures, including SLAP tears.
· Sometimes the diagnosis of a SLAP tear is made at the time of surgery.
Bankart Lesion
The Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. A Bankart lesion occurs when an individual sustains a shoulder dislocation. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart lesion.
Signs and Symptoms
◦ a sense of instability
◦ repeat dislocations
◦ popping, shoulders locking up
◦ catching sensations
◦ aching of the shoulder
Often patients will complain that they cannot "trust" their shoulder, fearing it may dislocate again.
Diagnosis
Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart lesion; therefore, there is a high suspicion of this injury whenever a patient dislocates their shoulder. On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.
Shoulder Dislocation
A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder blade (scapula). The shoulder joint is made of three bones which come together at one place. The arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder. A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula.
The joint between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint--the ball is on the top of the humerus, and this fits into a socket of the shoulder blade called the glenoid. This joint is incredible because it allows us to move our shoulder though an amazing arc of motion--no joint in the body allows more motion than the glenohumeral joint. A shoulder dislocation generally occurs after an injury such as a fall or a sports-related injury. About 95% of the time, when the shoulder dislocates, the top of the humerus is sitting in front of the shoulder blade--an anterior dislocation. In less than 5% of cases, the top of the humerus is behind the shoulder blade--a posterior dislocation. Posterior dislocations are unusual, and seen after injuries such as electrocution or after a seizure.
Signs and Symptoms
◦ significant shoulder pain
◦ Arm held at the side, usually slightly away from the body with the forearm turned outward
◦ Loss of the normal rounded contour of the deltoid muscle
Shoulder Separation
A shoulder separation is an injury to the acromioclavicular joint on the top of the shoulder. The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket.
A shoulder separation occurs where the clavicle and the scapula come together. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint. When this joint is disrupted, it is called a shoulder separation. Another name for this injury is an acromioclavicular joint separation, or AC separation.
A shoulder separation is almost always the result of a sudden, traumatic event that can be attributed to a specific incident or action. The two most common descriptions of a shoulder separation are either a direct blow to the shoulder (often seen in football, rugby, or hockey), or a fall on to an outstretched hand (commonly seen after falling off a bicycle or horse).
Signs and Symptoms
· Pain, usually severe at the time of injury.
· swelling and bruising
Diagnosis
The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination.
• Type I Shoulder Separation: A type I shoulder separation is an injury to the capsule that surrounds the AC joint. The bones are not out of position and the primary symptom is pain.
• Type II Shoulder Separation: A type II shoulder separation involves an injury to the AC joint capsule as well as one of the important ligaments that stabilizes the clavicle. This ligament, the coracoclavicular ligament, is partially torn. Patients with a type II separated shoulder may have a small bump over the injury.
• Type III Shoulder Separation: A type III shoulder separation involves the same type of injury as a type II separated shoulder, but the injury is more significant. These patients usually have a large bump over the injured AC joint.
• Type IV Shoulder Separation: A type IV shoulder separation is an unusual injury where the clavicle is pushed behind the AC joint.
• Type V Shoulder Separation: A type V shoulder separation is an exaggerated type III injury. In this type of separated shoulder, the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury.
• Type VI Shoulder Separation: A type VI shoulder separation is also exceedingly rare. In this type of injury the clavicle is pushed downwards, and becomes lodged below the corocoid (part of the scapula)
Shoulder Fracture
A fracture involves a partial or total crack through a bone. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. A fracture usually involves the clavicle or the surgical neck (area below the ball) of the humerus.
Signs and Symptoms
· Extreme pain
· Within a short time, there may be redness and bruising around the area, skin abrasions, swelling around back of shoulders
· bones appear out of position.
Diagnosis
X-ray
Sources:
1. http://www.uscfhealth.org/
The labrum is made of a thick tissue that is susceptible to injury with trauma to the shoulder joint. The labrum also becomes more brittle with age, and can fray and tear as part of the aging process.
Signs and Symptoms:
Depends on where the tear is located, but may include:
· An aching sensation in the shoulder joint
· Catching of the shoulder with movement
· Pain with specific activities, occasional night pain
· Popping, locking or grinding
· Decreased range of motion
· Sense of instability in shoulder
· Loss of strength
In addition, some types of labral tears, specifically a Bankart lesion, can increase the potential for shoulder dislocations.
SLAP tear
A SLAP tear is an injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within.
A specific type of labral tear is called a SLAP tear; this stands for Superior Labrum from Anterior to Posterior. The SLAP tear occurs at the point where the tendon of the biceps muscle inserts on the labrum.
How does a SLAP tear occur?
Common reasons for a SLAP tear include:
◦ Fall onto an outstretched hand
◦ Repetitive overhead actions (throwing)
◦ Lifting a heavy object
The area of the labrum where the SLAP tear occurs is susceptible to injury because it is an area of relatively poor vascularity. Other parts of the labrum often heal more easily because the blood supply delivers a healing capacity to the area of the tear. In the area of SLAP tears this is not the case, and chronic shoulder pain can result.
Signs and Symptoms
· catching sensation and pain with shoulder movements, most often overhead activities such as throwing.
· pain deep within the shoulder or in the back of the shoulder joint.
· SLAP tears with associated biceps tendonitis, patients may complain of pain over the front of the shoulder.
Diagnosis of SLAP tear
· shoulder physical examination.
· History taking
· SLAP tears tend to be seen best on MRI when the study is performed with an injection of contrast. A contrast MRI is performed by injecting a fluid called gadolinium into the shoulder; the gadolinium helps to highlight tears of normal structures, including SLAP tears.
· Sometimes the diagnosis of a SLAP tear is made at the time of surgery.
Bankart Lesion
The Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. A Bankart lesion occurs when an individual sustains a shoulder dislocation. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart lesion.
Signs and Symptoms
◦ a sense of instability
◦ repeat dislocations
◦ popping, shoulders locking up
◦ catching sensations
◦ aching of the shoulder
Often patients will complain that they cannot "trust" their shoulder, fearing it may dislocate again.
Diagnosis
Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart lesion; therefore, there is a high suspicion of this injury whenever a patient dislocates their shoulder. On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.
Shoulder Dislocation
A shoulder dislocation is an injury that occurs when the top of the arm bone (humerus) loses contact with the socket of the shoulder blade (scapula). The shoulder joint is made of three bones which come together at one place. The arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder. A shoulder dislocation occurs when there is an injury to the joint between the humerus and scapula.
The joint between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint--the ball is on the top of the humerus, and this fits into a socket of the shoulder blade called the glenoid. This joint is incredible because it allows us to move our shoulder though an amazing arc of motion--no joint in the body allows more motion than the glenohumeral joint. A shoulder dislocation generally occurs after an injury such as a fall or a sports-related injury. About 95% of the time, when the shoulder dislocates, the top of the humerus is sitting in front of the shoulder blade--an anterior dislocation. In less than 5% of cases, the top of the humerus is behind the shoulder blade--a posterior dislocation. Posterior dislocations are unusual, and seen after injuries such as electrocution or after a seizure.
Signs and Symptoms
◦ significant shoulder pain
◦ Arm held at the side, usually slightly away from the body with the forearm turned outward
◦ Loss of the normal rounded contour of the deltoid muscle
Shoulder Separation
A shoulder separation is an injury to the acromioclavicular joint on the top of the shoulder. The shoulder joint is formed at the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula), and the arm bone (humerus). The scapula and clavicle form the socket of the joint, and the humerus has a round head that fits within this socket.
A shoulder separation occurs where the clavicle and the scapula come together. The end of the scapula is called the acromion, and the joint between this part of the scapula and clavicle is called the acromioclavicular joint. When this joint is disrupted, it is called a shoulder separation. Another name for this injury is an acromioclavicular joint separation, or AC separation.
A shoulder separation is almost always the result of a sudden, traumatic event that can be attributed to a specific incident or action. The two most common descriptions of a shoulder separation are either a direct blow to the shoulder (often seen in football, rugby, or hockey), or a fall on to an outstretched hand (commonly seen after falling off a bicycle or horse).
Signs and Symptoms
· Pain, usually severe at the time of injury.
· swelling and bruising
Diagnosis
The diagnosis of shoulder separation is often quite apparent from hearing a story that is typical of this injury, and a simple physical examination.
• Type I Shoulder Separation: A type I shoulder separation is an injury to the capsule that surrounds the AC joint. The bones are not out of position and the primary symptom is pain.
• Type II Shoulder Separation: A type II shoulder separation involves an injury to the AC joint capsule as well as one of the important ligaments that stabilizes the clavicle. This ligament, the coracoclavicular ligament, is partially torn. Patients with a type II separated shoulder may have a small bump over the injury.
• Type III Shoulder Separation: A type III shoulder separation involves the same type of injury as a type II separated shoulder, but the injury is more significant. These patients usually have a large bump over the injured AC joint.
• Type IV Shoulder Separation: A type IV shoulder separation is an unusual injury where the clavicle is pushed behind the AC joint.
• Type V Shoulder Separation: A type V shoulder separation is an exaggerated type III injury. In this type of separated shoulder, the muscle above the AC joint is punctured by the end of the clavicle causing a significant bump over the injury.
• Type VI Shoulder Separation: A type VI shoulder separation is also exceedingly rare. In this type of injury the clavicle is pushed downwards, and becomes lodged below the corocoid (part of the scapula)
Shoulder Fracture
A fracture involves a partial or total crack through a bone. The break in a bone usually occurs as a result of an impact injury, such as a fall or blow to the shoulder. A fracture usually involves the clavicle or the surgical neck (area below the ball) of the humerus.
Signs and Symptoms
· Extreme pain
· Within a short time, there may be redness and bruising around the area, skin abrasions, swelling around back of shoulders
· bones appear out of position.
Diagnosis
X-ray
Sources:
1. http://www.uscfhealth.org/
PCL 4 - Differential Diagnosis (Arthritis & Frozen Shoulder)
Hey guys! (Isn't this a nice colour?? =D) Take note of the words in blue cos that's what I think are the main difference between the particular problem and the rotator cuff tendinopathy. Oh and the picture too!
Glenohumeral Arthritis (Shoulder Arthritis)
progressive weakening of the smooth joint cartilage
involved in inflammatory arthropathies such as Rheumatoid Arthritis (RA)
uncommon site for Osteoarthritis (OA)→ signs & symptoms of RA will differentiate glenohumeral arthritis with rotator cuff tendinopathy
Symptoms include
- Stiff shoulder (may appear like a frozen shoulder)
- Painful shoulder – related to movement
- Clicking, crunching or clonking sounds on movement
- Loss of shoulder movement
- (Not usually painful at night)
- Clearly identified on x-raycommonly anterior shoulder pain BUT for rotator cuff tendinopathy – pain in lateral deltoid area (aggravated by reaching overhead)
differentiation between glenohumeral joint disease and rotator cuff typically determined by history (see picture)
Adhesive Capsulitis (Frozen Shoulder)
What are the stages of a frozen shoulder?
- Painful/Freezing Stage
This is the most painful stage of a frozen shoulder. Motion is restricted, but the shoulder is not as stiff as the frozen stage. This painful stage typically lasts 6-12 weeks.- Frozen Stage
During the frozen stage, the pain usually eases up, but the stiffness worsens. The frozen stage can last 4-6 months.- Thawing Stage
The thawing stage is gradual, and motion steadily improves over a lengthy period of time. The thawing stage can last more than a year.
shoulder capsule becomes inflamed and stiff, greatly restricting motion and causing chronic pain
joint becomes so tight and stiff that it is nearly impossible to carry out simple movements, such as raising the arm
The movement that is most severely inhibited is external rotation of the shoulder
stiffness and pain worsen at night
usually dull or aching pain
worsened with attempted motion
limits to the active range of motion (range of motion from active use of muscles) are the same or almost the same as the limits to the passive range of motion (range of motion from a person manipulating the arm and shoulder)
Tuesday, July 27, 2010
PCL 4 - Pathophysiology of Rotator Cuff Tendinophathy by JinLi
http://video.about.com/orthopedics/Rotator-Cuff-Injury.htm
http://www.youtube.com/watch?v=6RbDkz737oA
http://upload.wikimedia.org/wikipedia/commons/6/62/Freestyle_swimming.gif
Swimming is an unusual sport in that the shoulders and upper extremities are used for locomotion, while at the same time requiring above average shoulder flexibility and range of motion (ROM) for maximal efficiency. This is often associated with an undesirable increase in joint laxity. Furthermore, it is performed in a fluid medium, which offers more resistance to movement than air. This combination of unnatural demands can lead to a spectrum of overuse injuries seen in the swimmer's shoulder, the most common of which is rotator cuff tendinitis.
- When you raise your arm above your head:
o The supraspinatus tendon (upper) and the subacromial bursa will glide on the acromion of scapula.
o The undersurface of acromion may be rough/abnormally shaped. It rubs or scrapes the bursa and tendon.
- Repetitive activities (with overhead motion) can result in
o Bursitis inflammation of bursa
o Tendinitis inflammation of tendon
Pathology
Tendinopathy = Tendinitis (inflammation) or tendinosis (tear)
- Normally, the rotator cuff moves within a confined space (subacromial space) with subacromial bursa (cushion between tendons and bone).
- When the subacromial space becomes smaller due to inflammation, bone spurs or fluid build-up, the rotator cuff tendons may be squeezed and rub against bone (impingement).
- As a result, the tendons may become damaged and irritated, causing bleeding and inflammation of the bursa or tendons.
- Over time, tendon may wear against the undersurface of acromion, causing TEAR & bleeding.
- Tears heal & replacement by scar tissue (weak/thickened/less flexible/fibrous)
- Gradual scarring of tendon - the entire rotator cuff weakens
- Finally, rotator cuff cannot balance the upward pull of the deltoid muscle
o This may further damage the tendon, renewing the cycle of tearing and scar formation
o The weaker the tendon becomes, the more susceptible it is to partial or complete tears
- Cycle of inflammation tearing of tendons scar formation
- This results in pain and loss of function
- Rotator cuff tears occur when the tendons become weak from inflammation/scarring/fraying
- Tears result from slow, progressive damage over time.
The rotator cuff is commonly injured by trauma (such as from falling and injuring the shoulder or overuse in sports). Rotator cuff injury is particularly common in people who perform repetitive overhead motions that can stress the rotator cuff. These motions are frequently associated with muscle fatigue
The factors below often occur together or overlap:
a. Bones are that irregularly shaped affect cuff movement in subacromial space
b. Normal wear and tear lead to changes in rotator cuff, such as:
a. General degeneration of the tendon thinning, fraying and tearing
b. Arthritis of the acromioclavicular (AC) joint results in bony growths that can damage rotator cuff
c. Joint looseness and muscle imbalance in the shoulder
d. Repetitive activities, especially forceful overhead motions
a. Repetitive activity – tendons rub or scrape against the acromion (this can irritate the rotator cuff)
b. Repeated overhead motions – damage stabilizing ligaments and result in an imbalance of opposing shoulder muscles (cause tendons to rub against the bones – impingement)
e. Overuse
a. Young athletes – tendinitis (throwing/swimming/racquet sports)
b. Lead to functional overload (shoulder joint becomes unstable)
c. The ball of humerus (humeral head) moves upward, narrowing the subacromial space where rotator cuff moves.
d. In this narrowed space, the rotator cuff is squeezed, forcing the tendon to rub against bone (impingement).
http://www.youtube.com/watch?v=6RbDkz737oA
http://upload.wikimedia.org/wikipedia/commons/6/62/Freestyle_swimming.gif
Swimming is an unusual sport in that the shoulders and upper extremities are used for locomotion, while at the same time requiring above average shoulder flexibility and range of motion (ROM) for maximal efficiency. This is often associated with an undesirable increase in joint laxity. Furthermore, it is performed in a fluid medium, which offers more resistance to movement than air. This combination of unnatural demands can lead to a spectrum of overuse injuries seen in the swimmer's shoulder, the most common of which is rotator cuff tendinitis.
- When you raise your arm above your head:
o The supraspinatus tendon (upper) and the subacromial bursa will glide on the acromion of scapula.
o The undersurface of acromion may be rough/abnormally shaped. It rubs or scrapes the bursa and tendon.
- Repetitive activities (with overhead motion) can result in
o Bursitis inflammation of bursa
o Tendinitis inflammation of tendon
Pathology
Tendinopathy = Tendinitis (inflammation) or tendinosis (tear)
- Normally, the rotator cuff moves within a confined space (subacromial space) with subacromial bursa (cushion between tendons and bone).
- When the subacromial space becomes smaller due to inflammation, bone spurs or fluid build-up, the rotator cuff tendons may be squeezed and rub against bone (impingement).
- As a result, the tendons may become damaged and irritated, causing bleeding and inflammation of the bursa or tendons.
- Over time, tendon may wear against the undersurface of acromion, causing TEAR & bleeding.
- Tears heal & replacement by scar tissue (weak/thickened/less flexible/fibrous)
- Gradual scarring of tendon - the entire rotator cuff weakens
- Finally, rotator cuff cannot balance the upward pull of the deltoid muscle
o This may further damage the tendon, renewing the cycle of tearing and scar formation
o The weaker the tendon becomes, the more susceptible it is to partial or complete tears
- Cycle of inflammation tearing of tendons scar formation
- This results in pain and loss of function
- Rotator cuff tears occur when the tendons become weak from inflammation/scarring/fraying
- Tears result from slow, progressive damage over time.
The rotator cuff is commonly injured by trauma (such as from falling and injuring the shoulder or overuse in sports). Rotator cuff injury is particularly common in people who perform repetitive overhead motions that can stress the rotator cuff. These motions are frequently associated with muscle fatigue
The factors below often occur together or overlap:
a. Bones are that irregularly shaped affect cuff movement in subacromial space
b. Normal wear and tear lead to changes in rotator cuff, such as:
a. General degeneration of the tendon thinning, fraying and tearing
b. Arthritis of the acromioclavicular (AC) joint results in bony growths that can damage rotator cuff
c. Joint looseness and muscle imbalance in the shoulder
d. Repetitive activities, especially forceful overhead motions
a. Repetitive activity – tendons rub or scrape against the acromion (this can irritate the rotator cuff)
b. Repeated overhead motions – damage stabilizing ligaments and result in an imbalance of opposing shoulder muscles (cause tendons to rub against the bones – impingement)
e. Overuse
a. Young athletes – tendinitis (throwing/swimming/racquet sports)
b. Lead to functional overload (shoulder joint becomes unstable)
c. The ball of humerus (humeral head) moves upward, narrowing the subacromial space where rotator cuff moves.
d. In this narrowed space, the rotator cuff is squeezed, forcing the tendon to rub against bone (impingement).
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