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However, imaging studies are unable to show cause of shoulder pain in diagnosing. For example, MRI imaging would show rotator cuff pathology and bursitis but is unable to specify the cause. [15] On physical exam, the physician may twist or elevate the patient's arm to test for reproducible pain (the Neer sign and Hawkins-Kennedy test).
Adults over the age of 60 are more susceptible to a rotator cuff tear, with the overall frequency of tears increasing with age. [92] By the age of 50 10% of people with normal shoulders have a rotator cuff tear. [93] In an autopsy study of rotator cuff tears, the incidence of partial tears was 28%, and of complete rupture 30%.
The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion. Squeezing of the rotator cuff is called impingement syndrome. [citation needed] An inflamed bursa is called bursitis. Tendinitis and impingement syndrome are ...
If conservative measures are unsuccessful, surgery can be trialed. Surgery to cut the adhesions (capsular release) may be indicated in prolonged and severe cases; the procedure is usually performed by arthroscopy. Surgical evaluation of other problems with the shoulder, e.g., subacromial bursitis or rotator cuff tear, may be needed.
The diagnosis is usually initially made by a combination of physical exam and medical imaging, where the latter may be projectional radiography (in cases of bony Bankart) and/or MRI of the shoulder. The presence of intra-articular contrast allows for better evaluation of the glenoid labrum. [8] Type V SLAP tears extends into the Bankart defect. [9]
Complications may include a Bankart lesion, Hill-Sachs lesion, rotator cuff tear, or injury to the axillary nerve. [1] A shoulder dislocation often occurs as a result of a fall onto an outstretched arm or onto the shoulder. [3] Diagnosis is typically based on symptoms and confirmed by X-rays. [2]
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-acromial ligament, acromion, and coracoid (the acromial arch) and from the deep surface of the deltoid muscle. [1]
The greater tuberosity of the humerus is also an illustrative location of occult fractures. The osseous injury may follow seizures, glenohumeral dislocation, forced abduction, or direct impaction. They are commonly discovered on MRI in symptomatic patients with suspicion of rotator cuff tear. Coronal images are best suited for detection.