Tendinitis of the Angular Scapula

Tendinitis of the angular scapula ❉ Etiology Angular tendonitis concerns the lower attachments of this muscle (scapular insertion). These tendinitis are encountered following exercises involving the neck (contralateral flexion and rotation of the head) or violent exercises of the ipsilateral shoulder. ❉ Diagnosis . Physical examination The patient generally consults for a low, unilateral torticollis. On inspection, the neck is slightly tilted to the painful side, a bulge secondary to muscle contraction is sometimes visible. The pain is located at the lower insertion of the angular. It is increased by tilting the head to the opposite side and opposing lowering of the shoulder stump. The painful point can be palpated under the trapezius. This tendonitis can sometimes be associated with cellular fatty damage to the subscapular sliding plane. In this case, crackles can be heard during active mobilization of the scapula. X-ray examination The cervical spine x-rayed from the front and in profile shows stiffness of the spine, sometimes an inversion of the curvature. 3/4 shots are normal. Ultrasound and MRI are of no interest. ❉ Treatment The treatment will combine relaxing and analgesic massages (three times/week), ultrasound and a relaxing drug treatment (Myolastan, Décontractyl, etc.). NSAIDs are rarely used in this type of pathology, given the weakness of the inflammatory component. The treatment will be extended to the dorsal and cervical spine (mobilization, bodybuilding), including the Static disorders that can be the cause of this tendinitis. ❉ Etiology Latissimus dorsi strains occur during internal rotation and adduction movements. ❉ Diagnosis . Physical examination Palpation of the back finds a unilateral or bilateral muscle contraction and sometimes an exquisite tender point at the injured region. The thwarted internal rotation causes pain in the injured region, as does the thwarted retropulsion. . X-ray examination Ultrasound can show disorganization of muscle fibers, intramuscular hematoma is exceptional. ❉ Treatment The treatment is identical to that proposed for the pectoralis major. ➢ Subscapularis tendonitis ❉ Etiology The main movements involved are internal rotations of the arm. ❉ Diagnosis . Physical examination Subscapularis tendinitis manifests itself as anterior shoulder pain. The latter is located in the deltopectoral groove (between the coracoid and the humerus). The pain is increased during adduction and contrary internal rotation of the arm. . Radiological examination Only MRI can show damage to the humeral insertion of this bone. In practice this examination will never be prescribed under these conditions. ❉ Treatment Anti-inflammatory treatment for this tendinitis must be early and intense to avoid the extension of this process to the groove of the long biceps. He will understand: . Multi-day cryotherapy . Daily physiotherapy (ionization and ultrasound). . NSAID prescription. Resumption of training will only be authorized after the complete disappearance of the inflammatory phenomenon. ➢ Coraco-brachialis tendonitis ❉ Etiology Coraco-brachialis tendonitis is rare and often difficult to distinguish from that of the pectoralis minor (the most common) and that of the short biceps. It originates from movements in flexion/adduction of the arm, exceptionally carried out iteratively otherwise in the weight rooms. ❉ Diagnosis . Physical examination The tendon of this muscle can be palpated at the level of its insertion on the coracoid. The pain is evident during retropulsion and internal rotation movements of the arm. . Radiological examination MRI can show an area of hyper brilliance on T2 which does not allow differentiation of coracobrachialis and short biceps injuries. ❉ Treatment Coracobrachialis tendonitis responds very well to ultrasound and MTP, if the lesion is old. NSAIDs are rarely necessary. ➢ Tendonitis of the small pectoralis ❉ Etiology Tendinitis of the pectoralis minor can be encountered during repetitive movements of the shoulder back and forth. The "push-ups", classic in handball as a "punishment", the pull-ups on a fixed bar generate this type of pathology. ❉ Diagnosis . Physical examination The patient presents with pain located on the coracoid process which is practically impossible to dissociate from tendonitis of the insertion of the short biceps. Palpation easily finds the exquisite painful point on this apophysis. The opposing lowering of the shoulder causes an increase in pain. . Radiological examination Only MRI is likely to show on T2 an area of hyper brilliance at the level of the coracoid process. ❉ Treatment The treatment is identical to that described for the coracobrachialis. ➢ Pectoralis major strain ❉ Etiology As for the other internal rotators of the shoulder, the pectoralis major strain occurs during blocked shots. ❉ Diagnosis . Physical examination The athlete feels violent pain in the middle part of his muscle. This pain can radiate into the arm. The thwarted adduction is responsible for pain in the affected region as well as the antepulsion (arm at 0°) and the thwarted internal rotation. If the patient is examined at a later stage a hematoma may have developed next to the lesion. . Unlike the latissimus dorsi, it is common to find a deep hematoma in the pectoralis major during the ultrasound study. ❉ Treatment The treatment combines, from the first day, multi-day cryotherapy with analgesic and anti-inflammatory electrotherapy. Immobilization of the arm is only proposed in the presence of significant pain. After the hematoma has disappeared and the lesion has healed (4 to 6 weeks), the rehabilitation will aim to stretch the muscle to restore its physiology; ultrasound can be used during this phase of the rehabilitation to defibrate the scar tissue.