Emergency Medicine

NON-ARTICULAR RHEUMATISM

328 Musculoskeletal and Soft-tissue Emergencies

2 There is pain and loss of a ll movement from an adhesive capsulitis.

3 Encourage active shoulder movements following the conditions above to

prevent the capsulitis in the first place.

4 Otherwise, prescribe an anti-inf lammatory analgesic and return the patient

to the care of the GP.

5 Physiotherapy may help, but although the pain subsides, the loss of

movement tends to persist for months or even years.

Rotator cuff tear: supraspinatus rupture

DIAGNOSIS

1 Sudden traction on the arm may tear the muscles that make up the rotator

cuff. The onset may be insidious, but a traumatic incident may complete a

tear causing sudden severe pain and reduced shoulder function.

2 Evaluate full active and passive range of movement at the glenohumeral joint.

(i) There is reduction of active shoulder motion with inability

to initiate abduction and weakness of external rotation of the

shoulder.

3 Tenderness is localized over the greater tuberosity and the subacromial

bursa, particularly with supraspinatus rupture. Other muscles forming the

rotator cuff may also tear but are difficult to differentiate clinically in the

acute stage.

4 Perform a shoulder X-ray that may reveal a decrease in the space between the

head of the humerus and the acromion.

5 Request an ultrasound, which is useful for characterizing the extent of full-

thickness rotator cuff tears and biceps tendon dislocation. It is less sensitive

for partial-thickness tears.

6 MRI is highly sensitive and specific for delineating size, location and charac-

teristics of rotator cuff pathology, when available.

MANAGEMENT

1 Refer an acute tear in a young patient to the orthopaedic team for considera-

tion of operative repair, to ensure an optimal return to a full range of

movement and function.

2 Give the elderly patient analgesics, an immobilizing sling and refer to the

physiotherapy department for a physical therapy rehabilitation programme.

SUPRASPINATUS TENDONITIS

DIAGNOSIS AND MANAGEMENT

(^1) This is one of the causes of the ‘painful arc’ with pain between 60° and 120°
of shoulder abduction.