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The shoulder
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
Diagnoses to consider are as follows: Supraspinatus tendinosis (subscapularis, infraspinatus).Rotator cuff tear.Frozen shoulder (adhesive capsulitis).Subacromial bursitis.Bicipital tendinosis (long head of the biceps).Osteoarthritis of the acromioclavicular, or glenohumeral, joint.Acute arthropathies, for example, rheumatoid, psoriasis and other seronegative arthropathies.Calcific tendinosis.
Biotensegrity
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Rotator cuff tendinopathy and associated subacromial bursitis are recognized clinical diagnoses, attributed to impingement of these structures between the greater tuberosity of the humerus and the overlying acromion. This diagnosis has been confirmed by MRI and ultrasonography in this 15-year-old patient; however, many questions remain. Why is a 15-year-old developing a degenerative process usually found in an aging population? Why is the contr alateral shoulder unaffected in this athlete, who is involved in swimming, a sport of symmetric movement? Does “overuse” and microtrauma in a young athlete actually explain this unilateral disease? On physical examination, her left scapula is more protracted with glenoid depressed, and the inferior angle more lateral as compared to the right. Speed’s, Neer Impingement, O’Brien’s and Empty-can tests were all positive. With active range of motion, there is mild scapular dyskinesis (i.e. altered scapular motion and position) on the left with limited active abduction to 145° and limited flexion to 160°.
Rheumatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Pain or limitation of movement at the shoulder:1 Supraspinatus tendonitis.2 Rotator cuff tear.3 Subacromial bursitis.4 Biceps tendonitis/rupture of long head.5 Frozen shoulder (adhesive capsulitis).
Ultrasound-guided versus blind subacromial bursa corticosteroid injection for paraplegic spinal cord injury patients with rotator cuff tendinopathy: a randomized, single-blind clinical trial
Published in International Journal of Neuroscience, 2021
Mohaddeseh Azadvari, Seyede Zahra Emami-Razavi, Farhad Torfi, Najmeh Sadat Boland Nazar, Ali Akbar Malekirad
Musculoskeletal pains are very common among SCI patients and different percentages have been reported in various studies [12]. Shoulder pain is one of the most common complaints of paraplegic SCI patients. Demographic factors as well as time duration of the injury and mobility from the wheelchair are among the effective factors on the shoulder pain [13]. Subacromial bursitis is the most important pathology of shoulder pain which is created as the result of over-use, in a potential location, just beneath the acromion bump; this makes the tendon of supraspinatus muscle prone to entrapment and tendinitis. Chronic pain has direct impacts on the quality of life of SCI patients as well as their mood [1,13]. Subacromial injection of corticosteroid mainly conducted in blind manner by anatomic landmarks is one of the effective treatments for this pain. Depending the body size of the patients, soft tissue thickness, physician experience and length of the needle, blind method could have some errors. On the other hand, the shoulder pain in these patients is usually chronic, resistant and recurring [14,15].
Differences of articular and extra-articular involvement in polymyalgia rheumatica: A comparison by whole-body FDG-PET/CT
Published in Modern Rheumatology, 2020
Koichiro Kaneko, Eiichi Suematsu, Tomoya Miyamura, Hisakazu Ishioka
In our study, the large joints had characteristic regions of intense accumulation regardless of the type of accumulation. Histological examination of the synovium and periarticular structures from the shoulder (joint capsule, bursa, and deep fascia) and of the tendinous septum from the deltoid muscle in PMR patients revealed non-specific inflammation with chronic inflammatory cells of a mild to moderate degree [3]. A recent FDG-PET/CT study showed that PMR patients tended to show localized FDG accumulation around the humeral head and these were suggestive of bursitis [17]. Several US and MRI studies have also detected bursitis in the shoulder region [4,6,7,19–21]. Our PMR patients showed intense FDG accumulation in the medial-to-subscapular region of the shoulder joint, corresponding to subacromial bursitis, and bursitis played a major role in the shoulder joints as in the ESS.
A very late presentation of polymyalgia rheumatica in a patient with giant cell arteritis: recurrence or casual association?
Published in Modern Rheumatology Case Reports, 2019
Helena Flórez, Sergio Prieto-González, Georgina Espígol-Frigolé, Maria C. Cid, José Hernández-Rodríguez
At the age of 87, the patient presented with new-onset pain with limited range of motion and morning stiffness in shoulder and pelvic girdles, together with worsening of the calf pain and intermittent claudication, mainly in the right lower limb. No fever, headache, jaw claudication or visual disturbances occurred and proximal segments of temporal arteries were normal at examination. Raised acute phase reactants (ESR 68 mm/1st hour, CRP 1.02 mg/dL) and anaemia (haemoglobin 110 g/L) were detected. A shoulder ultrasonography found cuff rotator tendinopathy signs without subacromial bursitis and normal thickening of the wall of axillary arteries. A new CT-angiography did not show changes compared to the previous angiographic findings (Figure 1(C)). A right temporal artery biopsy showed a disrupted muscular layer and intima-media junction area, partially replaced by connective tissue, without acute inflammatory changes, showing a fibrotic or reparative pattern (Figure 1(D)). A very late recurrence of GCA manifested as PMR with no overt vascular involvement (at that time) was considered. Prednisone at 20 mg/day was started with resolution of clinical and laboratory abnormalities. The patient suffered a new flare as PMR when a decrease below prednisone 7.5 mg/day was attempted, and after four years, he remains in remission on prednisone 5 mg/day. The patient signed an informed consent to publish this medical information.