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"The Shoulder" Demo

Combined rupture of supra- and infraspinatus

Clinical Presentation
Frequent lesion in the elderly (full thickness cuff tears exist in more than 30% of subjects above age 60).
A rupture is usually the final stage of progressive tendopathy due to repeated trauma, attrition, ischemia and impingement.
Together with degeneration and failure of the supra - and infraspinatus tendon, a marked bursitis with effusion is often present.

The clinical pattern is usually complex:

  • The active elevation is seriously limited (rupture of the supraspinatus and collection of fluid in the subacromial space).
  • Pain at the end of the passive ranges; maybe some limitation in a non-capsular way.
  • A marked painful arc.
  • Resisted abduction and lateral rotation are painful and weak.
  • Treatment:
    Injections in the subacromial space after aspiration of the fluid.
    10 ml procaine 0,5%, together with 20 to 30 mg triamcinolone are infiltrated using the technique for an uncomplicated chronic subdeltoid bursitis The infiltrations are repeated with increasing intervals (1 week, two weeks, three weeks ,one month and six weeks)

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