Shoulder problems: illustrated

Presentations of shoulder problems including burns, muscle wasting, dislocation, osteoarthritis, torn bicep, infection, soft tissue injury and rotator cuff syndrome.

Burns

BURNS

This 50-year-old woman fainted and collapsed against a radiator. She was alone and remained unconscious for an undetermined time, but came round to find these nasty burns on her shoulder. Although blistered, the wounds healed well, with minimal scarring.


Muscle wasting

MUSCLE WASTING

This man presented with a ‘dropped shoulder’ and pain, which he blamed on his heavy workbag. He was initially investigated for this and found to have muscle wasting of the deltoid and subscapularis muscles, which was secondary to severe cervical spondylosis at several levels, with a disc protrusion at C3/4. He was managed conservatively with aggressive physiotherapy.


Dislocated shoulder

DISLOCATED SHOULDER

This elderly woman fell over onto her right arm. She had some pain when she came to the surgery the next day, but it did not appear excessive. She had obvious swelling anteriorly, but a reasonable range of movement. She went to the hospital, where an X-ray confirmed the dislocation. It was subsequently reduced easily and she made a good recovery.


Osteoarthritis

OSTEOARTHRITIS

This woman presented with obvious swelling of the shoulder. She had a lot of pain and when examined, the shoulder demonstrated rather alarming, very loud crepitus. Her X-ray showed severe osteoarthritis, with complete loss of joint space. She is currently awaiting shoulder replacement surgery.


Torn biceps

TORN BICEPS

This 65-year-old man developed severe pain in his upper arm after falling off a ladder. It was some time before he presented to the practice and by then, it was too late to consider surgery. The patient had sustained a complete rupture of the biceps. He received physiotherapy and has managed well since then, although he has a 30% reduction in power in that arm.


Infection

INFECTION

This woman had a lot of pain in her shoulder. She went to an alternative practitioner, who treated her with a poultice of some sort. It is unclear what was in it, but it caused a significant skin reaction, which then became secondarily infected. The patient was reluctant to take conventional medicine, but eventually agreed to a course of oral antibiotics.


Soft tissue injury

SOFT TISSUE INJURY

This man presented with a swollen shoulder following a fall. He was referred for an X-ray, which showed a large joint effusion, but no fracture or dislocation. He was treated with anti-inflammatories and the effusion settled over a few days.


Rotator cuff syndrome

ROTATOR CUFF SYNDROME

The most common shoulder problem we see in general practice is rotator cuff syndrome. This often occurs in middle age and beyond, and is more commonly seen in women. There is usually no history of trauma and it can produce severe pain, especially at night, along with a restricted range of movement. Most patients will improve spontaneously or with physiotherapy, but a steroid injection is often given to relieve some of the pain.

  • Dr Phil Marazzi, GP, Surrey, UK

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