What are the most common shoulder problems?

Book in for a shoulder pain assessment and treatment where we can assess and ultrasound scan the shoulder o diagnose your shoulder problem.

Traumatic injury

Fractures, dislocations, ACJ separations have usually been seen in A&E or already had surgery, therefore usually only require rehab. Some labrum pathology such as fall on outstretched hand may also have also been previously diagnosed.

Non-traumatic injury

Adhesive capsulitis

3 to 1 female to male, 50+, loss of active and passive range of movement particularly lateral rotation. Corticosteroid and hydro dilation plus rehab.

ACJ arthrosis

Diagnosed on either x-ray or ultrasound, particularly sore end of range abduction and flexion, sometimes sore in horizontal adduction. Tender to palpate over the ACJ. Start with anti-inflams, ACJ mobs and strengthening of the shoulder girdle. This possibly requires an ultrasound guided steroid injection in to the ACJ.

Instability

These may already have dislocated several times or describe subluxations. Test with apprehension relocation test and sulcus test, these require lots of rehab and rotator cuff strengthening, and possibly a surgical review.

Labral pathology

Rarely seen and diagnosed in isolation. O’Brien’s test and external rotation, abduction and supination. These require an MR arthrogram.

Rotator cuff pathology

This includes tears, tendinopathy, calcific tendinitis, bursitis and subacromial impingement:

Calcific tendinitis

Two types: very acute or impingement type presentation.
The very acute severe shoulder patient will often have already been to A&E as they have gross loss of shoulder movement and extreme / severe pain. No other testing will be possible. They may have been told it’s a frozen shoulder, however if this is young male then it is unlikely. These are usually undergoing the acute resorptive phase which is very well seen on ultrasound. This acute calcific tendonitis requires an ultrasound guided steroid injection for pain relief.

The impingement type feel that they have something blocking a particular movement such as abduction or external rotation and have to click / flick their shoulder to be able to move. Cuff strength will be good with positive impingement tests. This is well seen as a stable calcific deposit in the rotator cuff tendon (supraspinatus and or infraspinatus) on US. This type of calcific tendonitis requires an ultrasound guided barbotage / lavage process with steroid injection / and or shockwave.

Rotator cuff tear

Rotator cuff weakness and possible impingement tests positive. Partial thickness or full thickness tears. Partial thickness tears are seen in the young. These should be conservatively managed with rotator cuff strengthening and you can also manage with a steroid injection into the bursa or PRP into the tear. Full thickness tear is usually in older population and can be managed by the rotator cuff and shoulder strengthening and ultrasound guided subacromial bursa steroid injection.

Partial thickness tear

Bursitis

No tests will diagnose this. This is seen quite well on ultrasound as a hypoechoic film within the peri-bursal fat and these are treated with a an ultrasound guided steroid injection into the bursa.

Rotator cuff tendinopathy

Rotator cuff weakness and possible impingement tests positive. As with all tendons they should be treated with load management and strengthening exercises. A course of shockwave therapy should also be considered and if the pain is still not settling an ultrasound guided injection with steroid or PRP into the tendon and the bursa could be trialled.