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Red flag pointers for shoulder pain
History of trauma (dislocation, fracture, rotator cuff tear)
Fever (septic arthritis, osteomyelitis)
Skin redness or swelling
History of inflammatory arthritis
Past history of cancer
Motor or sensory loss in arm
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TENDINOPATHY SYNDROMES, SUBACROMIAL BURSITIS AND ADHESIVE CAPSULITIS
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Guidelines Most of these disorders become chronic and persist for at least 12 mths but eventually spontaneous resolution can be expected.
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The tendinopathy syndromes (rotator cuff disease) usually have unrestricted active movements but resisted movements (e.g. abduction for supraspinatus tendinopathy) are painful.
Treatment: rest during acute phase, analgesics, peritendon injection. Imaging-guided injection, 1 mL corticosteroid with 2–5 mL 1% lignocaine.
Sometimes surgical intervention to divide a thickened coracoacromial ligament ± acromioplasty may be nec.
Subacromial bursitis presents in varying degrees from a ‘frozen shoulder’ to limited abduction (painful arc).
Treatment: injection of 5 mL, LA then 1 mL corticosteroid into and around the bursa.
Adhesive capsulitis or traumatic arthritis of the glenohumeral joint is a very painful condition with painful limitation of several active and passive movements, esp. rotation.
Treatment is with imaging-guided injection of intra-articular steroids or hydrodilation of the joint. Referral to a consultant is advisable as modern treatments, incl. arthroscopy, give excellent results.
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Rules of treatment (general)
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Pain, stiffness, ‘frozen’—arthroscopy to divide adhesions
Pain with mobility—hydrodilation or steroid injection