SHOULDER-SPECIFIC DIAGNOSES
Frozen shoulder Frozen shoulder, or adhesive capsulitis, is a painful and debilitating condition involving shoulder stiffness and loss of function (Rees et al., 2021). This condition is a pathological process in which excessive scar tissue or adhesions form across the glenohumeral joint (Le et al., 2017). Frozen shoulder is diagnosed by excluding other possible shoulder conditions (Kauta et al., 2021). It commonly affects patients who are 40 to 60 years of age. Females are affected more than males, and comorbidities such as diabetes, thyroid disorders, and Parkinson disease are associated with this condition. Diabetic patients develop the most severe form of frozen shoulder. Adhesive capsulitis can be primary or secondary. Primary adhesive capsulitis can occur spontaneously with no precipitating event. Secondary adhesive capsulitis is seen after several glenohumeral articular traumas, such as fracture or dislocation (Le et al., 2017). It can also occur after shoulder surgery. The incidence in the general population is approximately 3% to 5% but may be as high as 20% in patients with diabetes (Le et al., 2017). Clinically, adhesive capsulitis typically involves onset of shoulder pain followed by loss of both active and passive range of motion. External rotation is often the motion first affected, followed by loss of motion in all directions as the disease progresses (Le et al., 2017). Pain is often characterized as a dull ache that is poorly localized and that is typically worse at end range when the contracted capsule is stretched. Passive range of motion presents with a firm end feel (Le et al., 2017). Symptoms of glenohumeral joint arthritis are similar to those of adhesive capsulitis, and imaging may be used Subacromial shoulder pain/subacromial impingement Subacromial shoulder pain affects the structures that are present below the acromion (subacromial) and above the glenoid (supraglenoid). Rotator cuff pathologies in this group include tendinitis, calcific tendinitis, and rotator cuff tears. The subacromial bursa is also present in this area and can be a source of shoulder pain. Pain arising from rotator tendinopathy in the subacromial area is also referred to as impingement syndrome, as impingement occurs between the acromion and the rotator tendons (Kulkarni et al., 2015). According to Kulkarni et al. (2015), injuries to these structures account for up to 70% of all shoulder pain problems. Subacromial impingement occurs because of the confined anatomy between the acromion and glenoid. Numerous tendons course through this narrow space (Cotter et al., 2018). Subacromial impingement is associated with compression and inflammation of the supraspinatus tendon as it passes through the subacromial space. It is most often diagnosed in patients in their 60s (Chaimongkhol et al., 2020). New research has suggested that rotator cuff–related shoulder pain (RCRSP) is a more accurate overarching term to describe the condition known as impingement syndrome (Requejo-Salinas et al., 2022). When assessing for impingement syndrome (or rotator cuff–related shoulder pain), the subjective examination is important. According to Requejo-Salinas et al. (2022), 75% to 82% of diagnostic decisions related to assessing for this condition are reached based on the result of the subjective examination. Mechanical loading has a strong influence on the onset of pain in the subacromial structures (Requejo-Salinas et al., 2022). Specifically, the performance
for differential diagnosis. Differential diagnosis of other shoulder conditions with distinguishing findings include: ● Rotator cuff pathology : Distinguished by preservation of passive range of motion, focal tenderness, painful arc, and positive Neer and Hawkins tests. There is often a history of repetitive overuse with rotator cuff pathology as well as localized tenderness anteriorly and laterally (Ramirez, 2019). ● Acromioclavicular arthropathy : Tenderness localized superiorly over the acromioclavicular joint with positive cross-body adduction test. Glenohumeral range of motion is preserved (Ramirez, 2019). ● Biceps tendon pathology : Tenderness located anteriorly with positive Speed and Yergason tests (Ramirez, 20919). ● Cervical radiculopathy : Distinguished by posterior neck pain with painful limited cervical range of motion as well as weakness and numbness in the hand (Ramirez, 2019). ● Neoplasm : Distinguished by night sweats, fever, and unexplained weight loss. Coughing or dyspnea would be present with a Pancoast tumor (Ramirez, 2019). Self-Assessment Quiz Question #3 Frozen shoulder is characterized by stiffness and loss of shoulder range of motion. Which motion at the shoulder is often the first affected by loss of range of motion? a. Abduction. b. Flexion. of activities involving load in shoulder elevation, such as reaching into a high cupboard, is considered problematic. This condition is more prevalent on the dominant side with overhead sports and in the active working population (Requejo-Salinas et al., 2022). Overhead athletes such as tennis players and volleyball players may be more susceptible to this diagnosis. Those whose occupational performance includes activities such as heavy lifting or repetitive overhead activities (e.g., construction workers and painters) are also more susceptible to impingement syndrome (Linaker & Walker-Bone, 2015). The location of pain is most often the deltoid area, and this pain commonly affects sleep (Requejo-Salinas et al., 2022). The most common age for onset of impingement syndrome is between 45 and 55 years. Related symptoms in those older than 60 years of age are a risk factor for rotator cuff tear (Requejo-Salinas et al., 2022). Pain with resisted shoulder abduction and external rotation is considered key for this diagnosis (Requejo-Salinas et al., 2022). Weakness is most often noted in shoulder abduction and internal and external rotation (Requejo-Salinas et al., 2022). Special tests for subacromial impingement include: ● Neer impingement sign : For this test, the scapula is stabilized and then the patient’s arm is elevated. It is considered positive for impingement if the patient has pain between 70 and 110 degrees of elevation (Cotter et al., 2018) ● Jobe test : This test involves positioning the shoulder in 90 degrees of abduction, to 30 degrees of elevation, and internal rotation. The patient holds this position while the examiner pushes down on the patient’s arm. c. External rotation. d. Internal rotation.
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