Bursae Case Studies

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

This paper is going to be over rotator cuff injuries and what to do if this occurs to an athlete. The rotator cuff consists of four muscles which are the Subscapularis, infraspinatus, teres minor, and the supraspinatus and their associated tendons that insert into the Humerus. These groups of muscles are responsible for rotating the arm internally and externally as well as abducting the shoulder. The acronym for the four muscles of the rotator cuff is known as SITS. The best treatment for symptomatic, nontraumatic rotator cuff tears is unknown. The purpose of this trial was to compare the effectiveness of physiotherapy, acromioplasty, and rotator cuff repair for this injury. The way this trial worked was that 180 shoulders with the symptomatic,

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

Komblatt, the patient underwent extensive chiropractic treatment with 87 sessions from 10/07/11 through 07/11/12. It was opined that it does appear that the IW ha s undergone excessive passive-chiropractic treatment referable to both lumbar spine and right shoulder. It was further opined that the IW has reached MMI regarding the lumbosacral strain and contusion of the right shoulder within approximately 6-8 weeks post injury. Appropriate treatment would have consisted of aggressive right shoulder and low back rehabilitation to include aerobic conditioning, strengthening exercises involving the right upper extremity, lumbar spine and core, and resumption of normal recreational and work activities within 6-8

DOI: 6/12/2014. Patient is a 59-year-old right-handed male machine operator who sustained work-related injuries to his right arm, shoulder and neck when his right hand got caught in a mixer. As per office notes dated 9/6/16, the patient returns complains of continued neck pain with burning hot pain extending into the forearm down to the hand along the C6 and C7 distribution with numbness and tingling in the hand. The patient has undergone multiple medications, physical therapy, TEN both in physical therapy and home use. It was also noted that the pateint denies having cognitive behavioral therapy. The provider notes, that it would be appropriate as based on the history including postoperative right forearm fracture repair and forearm open reduction and internal fixation of the right distal radius that an additional surgery to the right arm and continue physical therapy, yet continues to have swelling

DOI: 5/8/2016. Patient is a 48-year old male maintenance operator who sustained a strained shoulder when he was throwing waste metal into a bin.The patient was subsequently diagnosed with left shoulder impingement syndrome with massive tear of the supraspinatus and infraspinatus tendons. MRI report dated 5/28/16 revealed suboptimal examination; massive full-thickness rotator cuff tear involving the entire supraspinatus and infraspinatus tendons with severe medial retraction beyond the level of the glenoid measuring approximately 6.2 cm. Severe fatty atrophy and loss of muscle bulk in the supraspinatus and infraspinatus muscles; large glenohumeral joint effusion with fluid in the subacromial/subdeltoid bursa and subcoracoid bursa; mild to moderate degenerative changes of the glenohumeral joint; severe acromioclavicular joint arthritis with

DOI: 3/19/2015. Patient is a 63-year-old right hand dominant male janitor who sustained injury while he was mopping when he began having right shoulder pain. Per OMNI, he was initially diagnosed with right shoulder impingement syndrome, neck strain and right shoulder strain.

DIAGNOSIS: Impingement syndrome, right shoulder; full-thickness rotator cuff tear with retraction, right shoulder; adhesive capsulites, right shoulder; post-op pain, right shoulder; Right elbow strain/sprain; Right wrist strain/sprain; Right upper extremity overuse syndrome.

Rotator cuff tendons are prone to degeneration leading to swelling with sub-luxation due to continuous active and passive forces. Rotator cuff pathology includes tendinopathy, tendinosis and bursitis, as well as rotator cuff tears. Most common indication for rotator cuff tears include increasing age and traumatic shoulder injury. Clinical symptoms for rotator cuff injuries include shoulder pain, weakness and loss of range of motion. However, these symptoms are common in various diseases; differential diagnosis includes labral tears, glenohumeral ligament tears or sprains, coracoacromial and arcomioclavicular ligament tears and sprains, osteoarthritis, adhesive capsulitis, proximal peripheral neuropathies and cervical radiculopathy. Hence,

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

Based on the progress report dated 06/27/16 by Dr. Mcclurg, the patient complains of sharp right shoulder pain, post-operative shoulder arthroscopy. Symptoms are moderate with significant limitations. PT is to be started on the next visit.

The supraspinatus muscle is the initial muscle for this movement during the first 15 degrees of its arc and past 15 degrees, the deltoid muscle becomes increasingly more effective at abducting the arm. The supraspinatus muscle is one of the musculotendinous support structures called the rotator cuff that surrounds the shoulder. In addition, it also helps to stabilize the shoulder joint by keeping the head of humerus firmly pressed medially against the glenoid fossa of the scapula. The most common form of injury in the shoulder is rotator cuff tendonitis. It involves the tendon of the supraspinatus muscle, which attaches to the upper portion of the upper portion of the humerus at the shoulder joint. Less commonly, the tendon of the infraspinatus

Rotator cuff is a group of four muscles including supraspinatus muscle, the infraspinatus muscle, teres minor muscle, and the subscapularis muscle. They connect the scapula to the head to the humerus (arm) , stabilize shoulder joint and contribute to shoulder joint movement including abduction, internal rotation, and external rotation of the shoulder. Rotator cuff problem such as injury or overuse of these muscles can cause shoulder pain which is characterised as pain around the shoulder and reduced shoulder joint

I have decided to look at rotator cuff injury and treatment. Initially this was because I have suffered some minor shoulder issues myself, largely associated with resistance (weight) training. However in the course of my research I recalled a plasterer who worked at our house some years ago complaining bitterly of what was very likely a rotator cuff injury. Working above head height and doing a repetitive series of movements is indeed one of the major risk factors (Macfarlane & Mcbeth, 2003).