Shoulder - Conditions

Subscapularis impingement is defined as impingement between the coracoid and lesser tuberosity.

Outlet impingement is the first stage of rotator cuff disease which is a continuum progressing from partial to full-thickness to massive rotator cuff tears, and finally to rotator cuff tear arthropathy.

Calcification and tendon degeneration near the rotator cuff insertion.

Tear in the rotator cuff tendons. Rotator cuff tears may involve individual tendons or a combination of tendons.

Shoulder arthritis in setting of rotator cuff dysfunction is defined as a combination of massive chronic rotator cuff tear, glenohumeral cartilage destruction, subchondral osteoporosis, humeral head collapse.

Well recognized as a pain generator in the shoulder. Often associated with other primary shoulder pathology subacromial impingement, stenosis of bicipital groove, rotator cuff tears and especially subscapularis pathology. The Pathoanatomy is more consistent with “tendinosis” than true inflammation.

Bicep tendon sometimes considered the 5th tendon of the rotator cuff involved in movement such as shoulder flexion and abduction. Most commonly associated with subscapularis tears, coracohumeral ligament tear, transverse humeral ligament tear.

Common injury making up 9% of shoulder girdle injuries. More common in males.

Loss of bone in the lateral clavicle, Caused by repetitive micro-fracture in distal clavicle which leads to osteopenia.

AC joint arthritis is caused by transmission of large loads through a small contact area. More common with age but can occur by second decade of life.

Risk factors;
Prior AC separations, commonly associated with individuals who engage in constant heavy overhead activities, especially in weight-lifters and overhead throwing athletes.

Traumatic Anterior Shoulder Instability (TUBS)
TUBS (Traumatic Unilateral dislocations with a Bankart lesion requiring Surgery);

• is one of most common shoulder injuries
• has a 1.7% annual rate in general population
• has a high recurrence rate that correlates with age at dislocation
• effects up to 80-90% in teenagers

Posterior shoulder dislocations are less common than anterior dislocations, but more commonly missed. 50% of traumatic posterior dislocations seen in the emergency department are undiagnosed. 2% to 5% of all unstable shoulders.

Risk factors;
Bone abnormality, glenoid retroversion or hypoplasia is a less common cause of instability, ligamentous laxity.

Also referred to as AMBRI;

• Atraumatic
• Multidirectional
• Bilateral (frequently)
• Rehabilitation (often responds to)
• Inferior capsular shift (best alternative to nonop)

Peaks in second and third decades of life.

Underlying mechanism includes;
Microtrauma from overuse:

• seen with overhead throwing, volleyball players , swimmers, gymnasts

Generalized ligamentous laxity:

• associated with connective tissue disorders: Ehlers-Danlos and Marfan's

Term for inferior dislocation of the glenohumeral joint. Very rare, only 0.5% of all shoulder dislocations.

Superior Labrum from Anterior to Posterior tears. May occur as isolated lesion or be associated with;

• internal impingement
• rotator cuff tears (usually articular sided)
• instability (may be subtle

Internal impingement refers to pathology on undersurface of rotator cuff.
In contrast to subacromial or “external” impingement which occurs on bursal side of rotator cuff) Internal impingement covers a spectrum of injuries including;

• fraying of posterior rotator cuff
• posterior and superior labral lesions
• hypertrophy and scarring of posterior capsule glenoid (Bennett lesion)
• cartilage damage at posterior glenoid

Major cause of shoulder pain in throwing athletes.

A condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side.
Occurs primarily in overhead athletes.
Often seen in baseball pitchers.

A condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side.
Occurs primarily in overhead athletes.
Often seen in baseball pitchers.

Commonly referred to as a reverse Bankart lesion.
May occur in all athletes due to trauma.
Most commonly occur in;

• football linemen (blocking)
• weightlifters (bench press)

Glenohumeral Arthritis
Glenohumeral degenerative joint disease has many causes including osteoarthritis, rheumatoid arthritis which is the most prevalent form of inflammatory process affecting the shoulder with >90% developing shoulder symptoms. Connective tissue diseases, spondyloarthropathies. It is commonly associated with rotator cuff tears. 25%-50% have full thickness tears. It is more common in the elderly, but may be associated with throwing athletes at younger age.

Defined as pain and loss of motion in shoulder with no other cause. It is associated with;

• diabetes (both types)
• thyroid disorders (autoimmune etiology)
• previous surgery (lung and breast)
• prolonged immobilization
• extended hospitalization

A condition caused by interruption of blood supply to humeral head. Causes include;

• Alcohol, AIDS
• Steroids (most common), Sickle, SLE
• Erlenmeyer flask (Gaucher's)
• Pancreatitis
• Trauma
• Idiopathic/ Infection
• Caisson's (the bends)

Scapulothoracic crepitus, or snapping scapula syndrome, manifests as pain at the scapulothoracic junction with overhead activity.

Can be caused by;
suprascapular notch entrapment;

• weakness of both supraspinatus and infraspinatus

spinoglenoid notch entrapment;

• weakness of infraspinatus only

Two types based on direction of top-medial corner of scapula;
medial winging:

• serratus anterior (long thoracic nerve)

lateral winging:

• trapezius (CN XI - spinal accessory nerve)

(Parsonage-Turner Syndrome) Clinical definition.
Brachial neuritis.
More formally called neuralgic amyotrophy (AKA Parsonage-Turner syndrome).

Risk factors;
Viral infection, immunizations, medications, extreme stresses, autoimmune diseases.

A neurovascular compressive neuropathy with either a neurogenic or vascular etiology. occurs in females > males.

Axillary nerve and posterior humeral circumflex artery compression in the quadrilateral (quadrangular) space. Rare and often misdiagnosed as subacromial impingement.

Axillary nerve and posterior humeral circumflex artery compression in the quadrilateral (quadrangular) space. Rare and often misdiagnosed as subacromial impingement.

Exclusively seen in males, often occurs in weightlifters and most commonly occurs as a tendinous avulsion.

Deltoid ruptures are usually strains or partial tears.
Complete ruptures are rare.

Risk factors;
Repeated corticosteroid injections about the shoulder, rotator cuff tear, trauma.

Usually males.
Age 30-50 most common.
Commonly seen in;

• competitive weightlifting
• body building
• football players

Rare condition but has been reported as a cause of pain in the thrower's shoulder.