MANUAL MINORS
Shoulder soft tissue injuries involve damage to the muscles, tendons, ligaments, and bursae that surround and stabilise the shoulder joint. These injuries are common due to the complexity and mobility of the shoulder and may result from overuse, repetitive movements, direct trauma, or ageing. Common injuries include rotator cuff tears, biceps tendon injuries, shoulder dislocations, and subacromial bursitis.
Diagnosis
Diagnosis is based on a clinical history of pain, functional limitation, or weakness in the shoulder, which may worsen with certain movements, such as raising or rotating the arm. Physical examination includes specific tests like Neer’s test (to assess for subacromial impingement) and Jobe’s test (to evaluate supraspinatus tendon tears). Ultrasound and magnetic resonance imaging (MRI) are useful for identifying rotator cuff tears, bursitis, or tendon injuries.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Rotator cuff tear | Pain and weakness when raising the arm, with significant functional limitation |
Bicipital tendinitis | Pain in the front of the shoulder, especially with flexion or supination movements |
Subacromial bursitis | Pain in the top of the shoulder, worsened by lifting the arm |
Shoulder dislocation | Acute pain with visible deformity after trauma or sudden movement |
Subacromial impingement syndrome | Chronic pain when lifting the arm, without visible tears |
Emergency Management
Emergency management includes pain control with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. If a severe injury, such as a complete tendon tear or dislocation, is suspected, the shoulder is temporarily immobilised with a sling, and the patient is referred for further evaluation, including imaging studies. Ice application and resting the shoulder are also recommended in the initial phase.
Definitive Treatment
Definitive treatment depends on the type of injury. Mild injuries, such as tendinitis or bursitis, usually improve with physical therapy, rest, NSAIDs, and activity modification. In cases of rotator cuff tears or recurrent shoulder dislocations, surgery may be required to repair damaged tissues or stabilise the joint. Physiotherapy is essential for both conservative management and post-operative recovery to restore mobility and prevent recurrence of the injury.
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