Deltoid Fibrosis Clinical Presentation

Updated: Jun 22, 2016
  • Author: Brian G Cothern; Chief Editor: S Ashfaq Hasan, MD  more...
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Presentation

History

The following may be noted in the patient’s history:

  • History of injections in and around the site of involvement
  • Similar contractures in other parts of the body
  • Family history of similar contractures
  • Significant limitation of the activities of daily living
  • Pain near the shoulder and neck
  • A dimple on the skin over the deltoid
  • A fibrous, palpable band
  • Scapular winging
  • An inability to pull the arm fully down to the side of the body
Next:

Physical Examination

Examine neck motion, looking for Sprengel deformity (high riding scapula) and other congenital abnormalities.

Examine shoulder and upper extremity to evaluate glenohumeral and scapulothoracic motion and stability. [15, 23]

Assess for winging of the scapula and freedom of scapular motion. [2]

Look for evidence of contractures elsewhere in both the upper and the lower extremities.

Perform a complete neurovascular examination.

Examine the thoracic and lumbar spine, looking for scoliosis or chest wall abnormalities.

The contracted portion of the deltoid determines the problems encountered by the patient. The shoulder is abducted when only the middle portion is involved. If the anterior portion is involved, the arm assumes a flexed and abducted position. If the posterior portion is involved, the arm is extended and abducted. As the arm is progressively extended or flexed, subluxation of the humeral head may occur. Most contractures are full thickness. However, a small group of individuals with only undersurface bands has been reported. These individuals experienced impingement and rotator cuff tears. Individuals in this group were skeletally mature.

Recurrent dislocation has been reported, as well as chronic labral injury. Radiologic evaluation of glenohumeral joint stability may be difficult because of changes in scapular position causing a relative overlap of the glenoid and humeral head. A bony projection can be present from the superolateral acromion and can indicate the formation of a traction enthesophyte. Computed tomography (CT) and magnetic resonance imaging (MRI) may be required to adequately evaluate the status of the glenohumeral articulation and the muscular architecture itself. [16]

In patients who are skeletally immature, flattening of the humeral head and changes in acromial morphology (drooping) may be seen. As the abduction contracture increases, [24]  the weight of the arm causes the inferior border of the scapula to rotate medially, resulting in winging of the scapula. Frequently, the skin may dimple, and a fibrous band may be palpable. Muscle aching about the shoulder girdle frequently accompanies the winging. Scoliosis secondary to more severe abduction contracture has been reported.

Individuals usually present with inability to move the arm across the body. Abduction of the arm releases the tension of the fibrous band and allows cross-body movement. An appropriate, full physical examination should be conducted by an orthopedic surgeon.

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