Subacromial Bursitis vs Rotator Cuff injury - USMLE Forums
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Old 11-07-2012
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Rheumatology/Orthopedics Subacromial Bursitis vs Rotator Cuff injury

how can we differentiate b\w 2 ? both have pain on abducting shoulder. both relieve on lidocaine injection. anyone ?
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Old 11-07-2012
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Originally Posted by tyagee View Post
how can we differentiate b\w 2 ? both have pain on abducting shoulder. both relieve on lidocaine injection. anyone ?
Im not sure because i hate orthopedics but prob the drop arm test would help you differentiate between the 2, as it is often present in rotator cuff injury?
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Old 11-07-2012
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Pain, weakness, and loss of shoulder motion are common symptoms reported with rotator cuff pathology. Pain is often felt over the anterolateral part of the shoulder and is exacerbated by overhead activities. Night pain is a frequent symptom, especially when the patient lies on the affected shoulder.
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to diagnose a full thickness rotator cuff tear, the best combination of tests, when all three are positive, were the: “the painful arc, the drop-arm sign, and weakness in external rotation”.


Drop-arm test


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Abduct the patient's shoulder to 90° and ask the patient to lower the arm slowly to the side in the same arc of movement.
Severe pain or inability of the patient to return the arm to the side slowly indicates a positive test result.
A positive result indicates a rotator cuff tear.


Hawkins test.


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The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
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Subacromial (subdeltoid) bursitis
  • The subacromial bursa lies between the acromion and the rotator cuff. It cushions the coracoacromial ligament from the supraspinatus muscle. When the arm is resting at the side, the bursa protrudes laterally from beneath the acromion. When the arm is abducted, it rolls medially beneath the bone. Subacromial bursitis is frequently associated with supraspinatus tendonitis because inflammation extends from one structure to the next.
  • Repetitive activities with an elevated arm most frequently cause inflammation of the bursae. Examples of this include frequent pitching of a baseball or lifting luggage overhead.
  • Less commonly, a primary process, such as rheumatoid arthritis, gout, or tuberculosis, may lead to bursitis.
  • Patients often exhibit tenderness over the greater trochanter. Difficulty in abduction may occur, specifically from 70-100 degrees.
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Decreased active elevation with normal passive ROM is usually observed in rotator cuff tears secondary to pain and weakness. When both active and passive ROM are decreased similarly, this usually suggests onset of adhesive capsulitis.
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Last edited by Novobiocin; 11-07-2012 at 11:51 AM.
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