Painful shoulder
Anatomy
- Shoulder joint is made up of a complex of five joints
- Sternoclavicular joint
- Acromioclavicular joint
- Subacromial space
- Glenohumeral joint
- Scapulothoracic joint
- Glenohumeral joint is stabilised by a number of muscles
- These include deltoid muscle and the rotator cuff muscles
- The rotator cuff is made up of:
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Clinical features
- Causes of shoulder pain include
- Impingement syndromes
- Rotator cuff tears
- Frozen shoulder
- Calcific tendonitis
Lateral epicondylitis
- Often referred to as tennis elbow
- Due to inflammation at the origin of the wrist and finger extensors
- Its is an enthesopathy of the lateral epicondyle
Clinical features
- Occurs between 30 and 50 years of age
- Men and women are equally affected
- 75% experience symptoms in their dominant arm
- Causes pain over the lateral epicondyle radiating to the forearm
- Tenderness is usually maximum 5 mm distal to the insertion of the tendon
- Resisted wrist extension increases the pain
- Plain x-ray may show calcification in the soft tissues
Management
- Non surgical management involves
- Rest
- Non-steroidal anti-inflammatory medication
- Steroid injection
- Surgical treatment if no improvement with 6 months conservative treatment
- Involves division and reattachment of the tendon
- 85% notice a dramatic improvement in symptoms
Medial epicondylitis
- Often referred to as golfer's elbow
- It is less common than lateral epicondylitis
- Occurs in same age group
- is is an enthesopathy of the pronator teres and flexor carpi radialis tendon
- Characterised by pain over the medial aspect of the elbow
- Pain is exacerbated by wrist flexion
- Tenderness is distal to medial epicondyle
- Management is similar to lateral epicondylitis
Ulnar nerve entrapment at the elbow
- Ulnar nerve runs behind medial epicondyle at the elbow
- Runs in a tunnel formed by aponeurosis between tow head of flexor carpi ulnaris
- Aponeurosis is slack in elbow extension
- Becomes tight in elbow flexion
- Disorders of the elbow joint can result in nerve compression
- Symptoms are often worse when elbow is flexed
Clinical features
- Pain and paraesthesia in the ring and little finger
- Weakness of grasp and grip
- Loss of manual dexterity
- Wasting of the intrinsic muscles of the hand
Management
- Night splints to reduce elbow flexion may improve symptoms
- Surgical options include
- Ulnar nerve decompression
- Medial epicondylectomy
- Anterior transposition
Bibliography
Buchbinder R, Green S, Bell S et al. Surgery for lateral elbow pain. Cochrane
Database Syst Rev 2002; CD003524.
Green S, Buchbinder R, Barnsley L et al. Non-steroidal anti-inflammatory drugs
(NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev 2002;
CD003686.
Smidt N, Assendelft W J, van der Windt D A et al. Corticosteroids for lateral
epicondylitis: a systemic review. Pain 2002: 96: 23-40. |