Shoulder Pain differential
Diagnosis
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Shoulder bursitis
What is Shoulder Bursitis?
Inflammation and swelling of any 8 bursae of the shoulder
Major bursae of the shoulder:
Subscapular Bursa:
Between tendon of subscapularis and shoulder joint capsule
Subdeltoid Bursa:
Between deltoid muscle and shoulder joint cavity
Subacromial Bursa:
Below acromion process and above the greater tubercle of the humerus
Subcoracoid Bursa:
Between the coracoid process of the scapula and shoulder joint capsule
What is the cause?
Acute trauma
Direct trauma to shoulder when playing sports or falling from bicycle etc.
Repeated
micro trauma
Throwing injuries
Bowling
Carrying heavy load unilaterally
Rotator Cuff injuries
Repetitive motion (work-related: assembly line)
Chronic irritation
Bacterial Infection
Inflammation secondary to Rheumatoid Arthritis
Signs and Symptoms:
Pain with all movement (especially Glenohumeral abduction)
Reproduce pain with:
Passive elevation and Internal rotation
Resisted abduction and External rotation
Sudden release after these maneuvers
Point tenderness over acromion
Swelling of bursa = Edematous feel to affected deltoid muscle
Functional disability
Unable to sleep on affected shoulder
Sharp, catching sensation with abduction, especially on first awakening
Chronic - Calcification may occur
Pain referral pattern:
Referral to the insertion of the deltoid at the deltoid tuberosity on the upper third of the humerus (Subdeltoid Bursitis)
Generally, can see pain at the outside of the shoulder and spreading towards the elbow
Diagnostic tool to rule in/out:
Physical examination
Observation
Palpation
Swelling of bursa and possible tendons
X-Ray
MRI
CT
Aspiration tests of the bursa
Special tests:
Impingement testing: Yocum’s, Neer’s, and Hawkins-Kennedy
Presentation of the disease:
Commonly presents in patients over 30 years old
Increased incidence seen in females
Painful shoulder motion with subdeltoid and subacromial bursitis, especially with abduction and extension.
Pain is gradual and can develop over a few weeks or months
Pain worsens with overhead activities
Interrupted sleep with an increase in pain with rolling onto the affected shoulder
Weakness in the muscles of the shoulder, but increased to normal range of motion
Tenderness to palpation over lateral shoulder and subacromial space; warmth and redness to skin