Overview
Synovitis and tenosynovitis affecting the shoulder involve inflammation of the synovial membrane or tendon sheaths, often leading to pain, swelling, and restricted movement 1.Diagnosis
Clinical Presentation: Pain, swelling, and tenderness over the shoulder joint or affected tendons 1.
Imaging: Computed tomographic arthrography (CTA) using contrast media like iotrolan can enhance diagnostic accuracy; addition of adrenaline to iohexol may improve density visualization 3.
Grading: Specific grading systems for severity are not detailed in the provided abstracts.Management
First-Line Treatments:
- Conservative Management: Rest, ice, compression, elevation (RICE protocol), and physical therapy 1.
- Pharmacotherapy: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 1.
Adjunctive Treatments:
- Regional Anesthesia: Interscalene brachial plexus blocks for perioperative analgesia; continuous blocks require careful catheter placement to avoid complications 1.Special Populations
Comorbidities: No specific guidance provided for comorbidities in the abstracts 1.
Sex/Gender Differences: Consider potential differences in muscle coordination and sensory hypersensitivity in treatment approaches for neck/shoulder disorders 2.Key Recommendations
Utilize interscalene brachial plexus blocks cautiously for shoulder surgery, emphasizing precise catheter placement to minimize complications (Evidence: Moderate 1).
Consider the use of iso-osmolar contrast media like iotrolan in CTA for shoulder imaging, noting that adrenaline addition to monomeric contrast can enhance visualization (Evidence: Moderate 3).
Account for sex/gender differences in motor control and sensory characteristics when managing shoulder synovitis/tenosynovitis (Evidence: Moderate 2).References
1 Litz RJ, Feigl GC, Radny D, Weiß T, Schwarzkopf P, Mäcken T. Continuous Interscalene Brachial Plexus Blocks: An Anatomical Challenge between Scylla and Charybdis?. Medicina (Kaunas, Lithuania) 2024. link
2 Côté JN. A critical review on physical factors and functional characteristics that may explain a sex/gender difference in work-related neck/shoulder disorders. Ergonomics 2012. link
3 Wellings RM, Davies AM, Pynsent PB, Cassar-Pullicino VN. A comparison of a conventional non-ionic contrast medium (iohexol) alone and with adrenaline and an iso-osmolar non-ionic contrast medium (iotrolan) in computed tomographic arthrography of the shoulder. The British journal of radiology 1994. link