Diseases in the Shoulder Joint Area①

The following are disorders commonly seen in the shoulder joint region.

  肩関節周囲炎、拘縮：Adhesive capsulitis (frozen shoulder), shoulder contracture
  腱板断裂：Rotator cuff tear
  反復性肩関節前方不安定症：Recurrent anterior shoulder instability
  石灰沈着性腱板炎：Calcific tendinitis of the rotator cuff
  投球障害肩：Thrower's shoulder （または Overhead athlete's shoulder disorder）
  非外傷性肩関節不安定症：Non-traumatic shoulder instability
 

Shoulder joint disorders and common chief complaints of outpatient visitors

 
・Pain　　　　　
・Limited elevation and movement disorders
　　

　Identifying the cause is the first step in treatment.
 

When exactly does the pain occur?

 
・Is the pain present at rest, that is, even when staying still?
・Does the pain occur during movement or activity?
 
It is very important to determine the intensity of the pain and when the pain occurs.
 

Clinical presentation of pain due to inflammation

 
・Pain at rest
・Pain with minimal movement
　　

　 Consider (or suspect) at the interview stage:
・ Severe pain
 

Treatment

• Rest and relaxation (instruction on how to relax the muscles)
• Steroid injections, hyaluronic acid injections
• Oral steroids

Steroids are effective drugs for reducing inflammation, but because they have strong side effects, their use is determined according to the presence of complications.
 

Clinical presentation other than pain due to inflammation

• No pain at rest
• Pain during movement
• Pain is present but manageable (can be controlled by the patient)

 
 　　　　　　　　

　
 
The next step is to perform a physical examination—that is, an assessment of shoulder movement.
 

My method of conducting the physical examination

 Measurement of range of motion

(The shoulder joint has the greatest range of motion among all joints in the human body. We move the shoulder in various directions to determine in which directions pain or other symptoms occur.)
 

Physical Examination 2

Muscle strength assessment

(We measure in which directions the shoulder can generate force and in which directions weakness is present.)

A preliminary evaluation is made up to this point.

 
・  Difference in range of motion between the affected and healthy sides
・  Whether there is weakness in any position
・  Presence or absence of impingement, etc.
 
　　　　　　　　

 
・  Difference between affected and healthy sides → Is there a contracture?
・  Weakness in certain positions → Is there a dysfunction of the rotator cuff?
・  Presence or absence of impingement → Is scapular movement impaired? Or is it due to rotator cuff tear affecting movement?