Summary

Shoulder dysfunction is usually caused by the shoulder capsule being too tight or too loose, by the rotator cuff musculotendinous unit being damaged or fatigued and less frequently from damage to the articular cartilage of the glenohumeral joint or acromioclavicular joint.

 

AC joint pain is the one shoulder disorder where pain is localized. Stiffness can be confirmed by testing external rotation motion and looseness by an apprehension test. Rotator cuff function can be checked, by assessing power of external rotation and supraspinatus, and impingement signs.

 

X-rays are useful for diagnosing calcific tendonitis, glenohumeral joint arthritis and cuff-tear arthropathy. Ultrasound is used to confirm a rotator cuff tear. A single corticosteroid injection in the relevant location is a useful first-line treatment for AC joint pain and impingement.

 

Persistent impingement, instability, stiffness and many rotator cuff tears can be restored effectively with minimally invasive arthroscopic surgery. Shoulder replacement is effective for treating severe gleno-humeral joint arthritis.

References

 

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Bhargav D, Murrell GAC: Shoulder stiffness: management. Aust Family Physician 33: 149-52, 2004

 

Bryant L, Shnier R, Bryant C, Murrell GAC: A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. J Shoulder Elbow Surg 11: 219-24, 2002

 

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Murrell GAC, Bhargav D: Medical and surgical manipulation of the shoulder capsule and labrum. APLAR J Rheum 2: 247-52, 1999

 

Murrell GAC, Walton J: Diagnosis of rotator cuff tears. Lancet 357: 769-70, 2001

 

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Paxinos A, Rutten S, Walton JR, Murrell GAC. Temporal outcomes of arthroscopic stabilization of superior labral (SLAP) tears with biodredable tac. in 27th Annual Meeting American Orthopaedic Society for Sports Medicine. 2001. Keystone, Colarado.: pp

 

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Tzannes A, Murrell GAC: Clinical examination of the unstable shoulder. Sports Medicine 32: 1-11, 2002

 

Tzannes A, Paxinos A, Callanan M, Murrell GAC: An assessment of the inter-examiner reliability of tests for shoulder instability. J Shoulder Elbow Surg 13: 18-23, 2004

 

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Yuan J, Murrell GAC, Wei A-Q, Wang M-X: Apoptosis in rotator cuff tendonopathy. J Orthop Res 20: 1372-9, 2002