Calcific Tendonitis
Definition
Mid-substance calcification of the rotator cuff
- part of a metaplasia secondary to hypoxia
Aetiology
2 groups of patients
Mid-substance calcification of the rotator cuff
- part of a metaplasia secondary to hypoxia
2 groups of patients
Due to scapulothoracic articulation disorder
1. Neurological Origin
A. Spinal Accessory Nerve / Trapezius palsy
B. Long Thoracic Nerve / Serratus Anterior palsy
C. Dorsal Scapular Nerve / Rhomboids palsy (rare)
2. Osseous Origin
Technique
- in plane of thorax
- oblique of GHJ
Grashey
- angle 45o lateral
- allows estimation of glenohumeral space
Terminal branch of the posterior cord
- lateral to radial nerve
- behind axillary artery
- runs over inferolateral border of SSC
- enters quadrangular space
Quadrangular space
- SSC superiorly anterior
- T major inferior
- T minor superiorly posterior
- long head triceps and humerus
Divides into anterior and posterior branches
Rare
- 2% of acute dislocations
Often missed
- < 1/ 52 25%
- < 6/52 25%
- < 6/12 25%
- > 6/12 25%
Instability in at least 2 planes
- postero-inferior
- antero-inferior
- antero-postero-inferior
Recognised as a common problem
- often misdiagnosed
Most patients athletic
A GH dislocation which has been missed for a significant period of time
- time period is arbitary
- > 3-6 weeks
Humerus soft and osteoporotic
Significant soft tissue contractures
1. Anterior / subcoracoid dislocation
Beware
- scarring to NV structures
- RC tears including SSC, especially > 40
Most common form of shoulder instability
- young males
- M:F = 2:1
Indirect ER and abduction moment on arm
- disruption of anterior stabilisers
Initial injury
- severe pain in shoulder
Idiopathic inflammatory condition
- characterised by progressive shoulder pain & stiffness
- due to contracture of capsuloligamentous structures
- spontaneously resolves
2% incidence
- 40 - 60 years
- Women 2:1
Sedentary workers
- Non-dominant limb
Bilateral in 10 - 40%
Much less common than hip OA
- usually presents late
Similar causes as hip (AS IT GRIPS 3C)
Alcohol / Steroid / Trauma / Idiopathic
Gauchers
RA / RTx
Sickle Cell