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

Bhargav D, Murrell GAC: Shoulder stiffness: diagnosis. Aust Family Physician 33: 143-7, 2004

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

Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, Kobayashi M: A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. J Shoulder Elbow Surg 12: 413-5, 2003

Jobe FW, Kvitne RS, Giangarra CE: Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement [published erratum appears in Orthop Rev 1989 Dec;18(12):1268]. Orthop Rev 18: 963-75, 1989

Murrell GAC: Treatment of shoulder dislocation: is a sling appropriate? Medical Journal of Australia 179: 370-1, 2003

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

O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB: The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 2: 610-43, 1999

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

Silliman JF, Hawkins RJ: Current concepts and recent advances in the athlete’s shoulder. Clin Sports Med 10: 693-705, 1991

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

Walton J, Paxinos A, Mahajan S, Marshall J, Bryant C, Shnier R, Quinn R, Murrell GAC: Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surgery (Am) 86: 807-12, 2004

Walton J, Paxinos A, Tzannes A, Callanan M, Hayes K, Murrell GAC: The unstable shoulder in the adolescent athlete. Am J Sports Med 30: 758-67, 2002

Walton J, Tzannes A, Murrell GAC. The predictive value of clinical tests for shoulder instability. in 47th Annual Meeting Orthopaedic Research Society. 2001. San Francisco: Orthopaedic Research Society, pp 0288

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