Soft tissue lesions of the shoulder

Last updated: April 26, 2022

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Soft tissue lesions of the shoulder are usually caused by the narrowing of the subacromial or subcoracoid space and subsequent entrapment of soft tissues. These structural changes in the shoulder joint are often the result of overuse (e.g., repetitive overhead arm movements) and degenerative or inflammatory processes. The main symptom of soft tissue involvement is shoulder pain caused by impingement of soft tissue, most commonly of the supraspinatus tendon arm abduction over 60°. Further symptoms include nocturnal pain, pain on palpation, and stiffness of the joint. Chronic entrapment of the tendons can lead to tendinitis, which increases the risk of tendon rupture, especially of the rotator cuff tendons. Soft tissue injury of the shoulder is usually diagnosed clinically. Additional imaging tests (x-ray, MRI) can be used to determine the extent of damage. Management involves avoiding overhead activities, NSAIDs, and physical therapy. Intraarticular corticosteroid injections and surgical measures may be required in refractory cases.

References:[1]

Subacromial impingement syndrome

Rotator cuff tendinitis

Frozen shoulder (adhesive capsulitis)

Calcific tendinitis

Calcific tendinitis is covered in detail in “BCP crystal deposition diseases.”

Clinical examination

For detailed explanations of the clinical tests, see “Orthopedic shoulder examination.

Subacromial lidocaine injection test [4]

Imaging

Glucocorticoid injections can lead to tendon degeneration and should, therefore, be administered with restraint.

Rotator cuff tear

  • Etiology [6]
  • Clinical features
    • Most commonly affects the supraspinatus tendon
    • Acute rupture: acute severe pain and loss of strength
    • Degenerative rupture: chronic pain; loss of strength is less pronounced
    • Restricted range of motion (depending on the muscle involved)
  • Diagnostics
  • Treatment
    • Treatment of degenerative tears is often conservative, especially in older and/or sedentary patients (see “Conservative treatment” above).
    • Surgical repair; of the rotator cuff is recommended in patients with traumatic rupture, especially those who are physically active or who do not respond to conservative treatment.

We list the most important complications. The selection is not exhaustive.

  1. Zlatkin MB. MRI of the Shoulder. Lippincott Williams & Wilkins ; 2003
  2. Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005; 331 (7530): p.1453-1456. doi: 10.1136/bmj.331.7530.1453 . | Open in Read by QxMD
  3. Nagy MT, MacFarlane RJ, Khan Y, Waseem M. The Frozen Shoulder: Myths and Realities. The Open Orthopaedics Journal. 2013; 7 (1): p.352-355. doi: 10.2174/1874325001307010352 . | Open in Read by QxMD
  4. McFarland E, Bernard J, Dein E, Johnson A. Diagnostic injections about the shoulder. J Am Acad Orthop Surg. 2017; 25 (12): p.799-807. doi: 10.5435/jaaos-d-16-00076 . | Open in Read by QxMD
  5. MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. Journal of Shoulder and Elbow Surgery. 2000; 9 (4): p.299-301. doi: 10.1067/mse.2000.106918 . | Open in Read by QxMD
  6. Hsu J, Keener JD. Natural History of Rotator Cuff Disease and Implications on Management. Operative Techniques in Orthopaedics. 2015; 25 (1): p.2-9. doi: 10.1053/j.oto.2014.11.006 . | Open in Read by QxMD

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