Soft Tissue Injuries of the Shoulder

Rotator Cuff Tendinopathy/Tear | Frozen Shoulder | Subacromial Impingement | Subacromial Bursitis | Glenohumeral Joint Osteoarthritis | References

Rotator Cuff Tendinopathy/Tear

Definition: Rotator cuff tendinopathy refers to inflammation or irritation of the tendons of the rotator cuff muscles, often due to overuse or repetitive strain. A rotator cuff tear involves a partial or complete tear of one or more tendons of the rotator cuff.

Aetiology: The condition is often caused by repetitive overhead activities, trauma, or age-related degeneration.

Pathophysiology: Chronic overuse leads to microtrauma and inflammation of the tendons, resulting in tendinopathy. In more severe cases, continued stress can lead to tendon tears.

Risk Factors: Age (over 40), participation in overhead sports, occupations requiring repetitive shoulder movements, and a history of shoulder injuries.

Signs and Symptoms: Shoulder pain, particularly during overhead activities; weakness in the shoulder; and difficulty lifting the arm. A tear may also cause a catching or grating sensation.

Investigations: Physical examination (painful arc, weakness), ultrasound or MRI to confirm a tear.

Management:

• Primary Care: Rest, activity modification, NSAIDs, physiotherapy.
• Specialist Care: Corticosteroid injections, surgery for significant tears.

Frozen Shoulder (Adhesive Capsulitis)

Definition: Frozen shoulder is a condition characterised by pain and progressive stiffness of the shoulder joint due to inflammation and thickening of the joint capsule.

Aetiology: The exact cause is unknown, but it is often associated with prolonged immobility, diabetes, or previous shoulder injuries.

Pathophysiology: Inflammation of the joint capsule leads to fibrosis and adhesion formation, resulting in restricted movement.

Risk Factors: Age (40-60 years), female gender, diabetes, thyroid disorders, and prolonged shoulder immobility.

Signs and Symptoms: Gradual onset of shoulder pain and stiffness, with a significant reduction in the range of motion.

Investigations: Clinical diagnosis based on history and examination; MRI may be used to rule out other conditions.

Management:

• Primary Care: Pain management with NSAIDs, physical therapy to maintain range of motion.
• Specialist Care: Corticosteroid injections, manipulation under anaesthesia, or arthroscopic capsular release in severe cases.

Subacromial Impingement

Definition: Subacromial impingement occurs when the tendons of the rotator cuff are compressed during shoulder movements, particularly when lifting the arm.

Aetiology: The condition is often due to repetitive overhead activities or structural abnormalities such as a hooked acromion.

Pathophysiology: Repetitive impingement leads to inflammation and microtrauma to the rotator cuff tendons and subacromial bursa, contributing to pain and dysfunction.

Risk Factors: Age, overhead activities, structural abnormalities of the acromion, and previous shoulder injuries.

Signs and Symptoms: Shoulder pain, particularly with overhead activities, and weakness in the arm.

Investigations: Clinical examination (Neer's test, Hawkins-Kennedy test), ultrasound, or MRI to assess soft tissue structures.

Management:

• Primary Care: Rest, activity modification, NSAIDs, physiotherapy.
• Specialist Care: Corticosteroid injections, surgical decompression (subacromial decompression) if conservative treatment fails.

Subacromial Bursitis

Definition: Subacromial bursitis is the inflammation of the subacromial bursa, a fluid-filled sac that reduces friction between the rotator cuff tendons and the acromion.

Aetiology: Often caused by repetitive shoulder movements, trauma, or associated with rotator cuff tendinopathy or impingement syndrome.

Pathophysiology: Inflammation of the bursa leads to swelling and pain, which can compress the underlying rotator cuff tendons, exacerbating symptoms.

Risk Factors: Repetitive overhead activities, trauma, and coexisting rotator cuff pathology.

Signs and Symptoms: Shoulder pain, particularly with overhead movements, and tenderness over the subacromial space.

Investigations: Clinical examination, ultrasound to assess bursal swelling, and MRI if needed.

Management:

• Primary Care: Rest, ice, NSAIDs, physiotherapy.
• Specialist Care: Corticosteroid injections, aspiration of the bursa if there is significant swelling, surgical intervention in chronic cases.

Glenohumeral Joint Osteoarthritis

Definition: Glenohumeral joint osteoarthritis is a degenerative condition characterised by the breakdown of articular cartilage in the shoulder joint, leading to pain and stiffness.

Aetiology: Age-related wear and tear, previous shoulder injuries, or inflammatory conditions such as rheumatoid arthritis.

Pathophysiology: The loss of cartilage leads to bone-on-bone contact, causing pain, inflammation, and reduced joint mobility.

Risk Factors: Age, previous shoulder injuries, inflammatory arthritis, and genetic predisposition.

Signs and Symptoms: Shoulder pain, stiffness, reduced range of motion, and crepitus (grating sensation) during movement.

Investigations: X-rays to assess joint space narrowing, osteophyte formation, and subchondral sclerosis; MRI for detailed soft tissue assessment.

Management:

• Primary Care: Pain management with NSAIDs, physical therapy to maintain joint function, activity modification.
• Specialist Care: Corticosteroid injections for inflammation, hyaluronic acid injections, and surgical options such as arthroplasty (joint replacement) in severe cases.

References

1. NHS (2024) Shoulder Pain. Available at: https://www.nhs.uk/conditions/shoulder-pain/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Shoulder Pain: Assessment and Management. Available at: https://cks.nice.org.uk/topics/shoulder-pain/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Shoulder Disorders: Clinical Features, Diagnosis, and Management. Available at: https://www.bmj.com/content/350/bmj.h4200 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Rotator Cuff Disorders and Shoulder Osteoarthritis. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/rotator-cuff-tears/ (Accessed: 24 June 2024).

Back to Top