Case Based

Learning

I ** Hate Anatomy
SUBJECT : 30 year old weight lifter
Problems: Pain and stiffness in shoulder
Surface Diagnosis: Subject unable to perform
initial 15 degree abduction of arm
• The shoulder joint is made up of humerus, the scapula (or shoulder
blade), and the clavicle (or collarbone).
• The shoulder is actually made up of two separate joints - the
glenohumeral and acromioclavicular joints.
• The glenoid fossa forms a very shallow socket, so the muscles,
ligaments, and cartilage of the shoulder joint reinforce its structure
and help to prevent dislocations
MAJOR LIGAMENTS OF SHOULDER JOINT
Possible causes :Overuse of poorly conditioned tissues is the common
cause. The shoulder tendons are wide bands of collagen fibers. If stress
roughens a tendon, its tensile strength decreases. This leads to fibrinoid
degeneration in and between the collagen fibers and later fibrosis. With
necrosis and the initial inflammatory reparative process, the local tissues
become alkaline, which induces precipitation of calcium salts. This deposition
may evade an overlying bursa.
• Roots C5 and C6
• Superior trunk of brachial plexus
• SUPRASPINATUS TENDINITIS: Inflammation of paratendinous
supraspinatus tissues is often a part of subdeltoid or subacromial bursitis. It is
also frequently a part of rotator cuff injury and a complication of severe
supraspinatus strain. An ache is present on rest which is aggravated by abduction.
Pain may be referred as far distal as the deltoid insertion. The distinguishing
feature is that pain is restricted to movement only within a certain point of the
arc (painful arc syndrome). This is because the acromion process affects the
tendon area only during part of its excursion. Point tenderness will be found over
the site of inflammation. The patient will complain that it is painful to sleep on
the affected side. Treatment is similar to that of bicipital tendinitis. 
• Rotator cuff tear: tendons are mostly damaged. Supra-spinatous is
mostly involved. usually occurs at its point of insertion onto the
humeral head at the greater tubercle.
A goniometer is a device used in physical therapy to measure the range
of motion around a joint in the body.
 Treatment
• Oral medications that provide pain relief such as anti-inflammatory agents, topical pain relievers
such as cold packs, and if warranted, subacromial corticosteroid/local anesthetic injection.[38] An
alternative to injection is iontophoresis, a battery-powered patch which "drives" the medication
to the target tissue. A sling may be offered for short-term comfort, with the understanding that
undesirable shoulder stiffness can develop with prolonged immobilization. Early physical therapy
may afford pain relief with modalities (e.g. iontophoresis) and help to maintain motion.
• Ultrasound , cryotherapy, hyperthermia, transcutaneous electrical nerve stimulation and
extracorporeal shock wave therapy have a beneficial effect on the recovery of supraspinatus
tendinitis. But we have to remember that it is very important to use these methods as an adjunct
to physical therapy