Test your knowledge: anterior shoulder pain
Question:
During daily practice, patients present with problems during movement that can cause pain and inability to move adequately. In the initial session, a patient’s problems are investigated and a diagnosis is made. An important part of this intake session is asking the patient to describe the suspected cause of the complaint and if any limitations during daily functioning are experienced.
In this case, a patient seen in the clinic was asked to describe the cause of her problem. She stumbled over a tree root and fell forward. Her arm got stuck behind a tree branch during her fall. After this event she has had a lot of pain in the anterior shoulder region.
Do you know what structure might be damaged due to her fall? Use the pictures to established a viewpoint regarding the damaged structure (radiographs didn’t reveil any abnormalities).
Answer:
During her fall, the aforementioned patient damaged subscapularis tendon. In the ultrasonography pictures (longitudinal and transverse) you can distinguish a black zone in the tendon. This is a hypo-echogenic part in the tendon; this can a.o. be intra-tendinous fluid due to macro damage. The picture of the patient that was referred to in the earlier post shows the belly press exercise. The belly press is a test for subscapular muscle or tendon injury. In the picture below you can see the test with its description. Use it in combination with other lag signs and shoulder tests.
(Image by: scielo.br)