March 2021: Injury Without Trauma

She was actively holding her arm against her side, her hand wrapping around her wrist. Any attempt to move her shoulder, actively or passively, brought an involuntary wince of pain. Tears quickly followed.My patient, a woman in her 40s, described increasing diffuse shoulder pain over two days. There was no trauma, but she described excruciating pain. She couldn't raise her arm at all, so I thought about a rotator cuff injury.She had had no injury, but rotator cuff tendons can give way to repetitive injury that thins the tissue until one day it just it breaks. It seemed more agony than this etiology would give. Maybe there was more to the story. Could an x-ray help? There was the answer: calcific tendonitis of the supraspinatus muscle. This is the most common location of calcific tendonitis and completely explains this patient's tortured shoulder. Pain can be caused by chemical irritation from the calcium deposits in the tissue, tissue swelling causing pain, or a subacromial impingement syndrome.This is actually a classic story. Patients with symptomatic calcific tendonitis are most commonly women between 30 and 50 with exquisite, atraumatic shoulder pain. The treatment is NSAIDs. If steroids are used, this is most commonly by injection. For those rare cases that are more resistant, removal of the calcium deposit may be required by excision or ultrasound-guided barbotage.Tip to Remember: Sometimes orthopedic radiographs are helpful even when there is no trauma.Tag...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs