Chronic Shoulder Disorders

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Ernest Moody
5 years ago
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1 Chronic Shoulder Disorders Dr. Mustafa Elsingergy Consultant orthopedic surgeon Dallah Hospita Prof. Mamoun Kremli Almaarefa Medical College

2 Contents

3 INTRINSIC Shoulder Pain Due to causes in the shoulder region EXTRINSIC Due to referred pain from outside the shoulder

4 INTRINSIC Shoulder Pain Due to causes in the shoulder region

5 EXTRINSIC Shoulder Pain Due to referred pain from outside the shoulder

6 Shoulder Disorders Due to causes related to : 1. Rotator cuff 2. Shoulder capsule 3. Glenohumeral joint 4. Scapular problems 5. Acromioclavicular joint

7 Rotator Cuff - Anatomy Originate from the scapula Insert in the Greater Lesser tuberosities Pass under coraco-acromial arch Separate from the ligament by bursa

8 Rotator Cuff Disorders Acute tendinitis Impingement syndrome Rotator cuff tear

9 R.C.D - Acute Tendinitis Clinical features: Pain / Tenderness / Painful abduction range X-ray: Normal Area of calcification Treatment: Rest NSAID Local injection

10 R.C.D - Impingement Syndrome Causes Clinical features Pain Shoulder looks normal or wasted Tenderness Disturbed glenohumeral rhythm Painful abduction ( 6o o TO 120 o ) Neer s test (+VE) Hawkin s test (+ve)

11 R.C.D - Impingement Syndrome X-ray: Calcification Degenerated AC jt. MRI: Bursitis Thickening of the tendon Treatment: Mild: NSAID, local injection Severe: arthroscopy vs acrmoioplasty

12 R.C.D - Impingement Syndrome Predisposing factors Degeneration: middle age Chronic irritation by osteophyte Underlying disease: eg. Rheumatoid Precipitating factor: trauma Types: Incomplete Complete

13 R.C.D - Impingement Syndrome Clinical features: Trauma, pain, limited abduction After few weeks: Incomplete tear: improvement of pain and rom Complete tear: improvement of pain and decrease of active range Look: Early; normal appearance Late; wasting of supraspinatus and infraspinatus muscles Feel: Tender greater tuberosity

sign X-rays: Early normal Late degenerative changes MRI: image of

14 R.C.D - Rotator Cuff Tear Clinical features: Move: Incomplete tear; painful weak Complete; passive not painful, active drop arm sign X-rays: Early normal Late degenerative changes MRI: image of choice Treatment: Incomplete tear: PT, NSAID Complete tear: surgery

15 Biceps Tendon Disorders Tendinitis: Pain Tenderness: Bicepital groove Painful forward flexion Treatment: NSAID, local injection Tear of long head of biceps tendon: Pain Deformity of biceps contour (Popeye s arm) No need for treatment

Adhesive Capsulitis (Frozen Shoulder) Unknown pathogenesis leads to pain and limitation of movement Trauma or RCD may be causes Clinical features: Pain Limitation of movement

16 Adhesive Capsulitis (Frozen Shoulder) Unknown pathogenesis leads to pain and limitation of movement Trauma or RCD may be causes Clinical features: Pain Limitation of movement in all directions of GH range Natural history: Pain and limitation of movement gradually increase then gradually decrease, takes 18 months Treatment: Conservative vs arthroscopy

17 Recurrent Shoulder Instability Types: Recurrent anterior dislocation (RAD) Recurrent posterior subluxation (rare) Multidirectional instability (MDI) Type RAD MDI Cause Traumatic Atraumatic Clinical feature Apprehension test +ve Sulcus sign positive Treatment Surgical PT

18 Recurrent Shoulder Instability Multidirectional instability: Generalized ligamentous laxity Sulcus sign (+ve)

19 Recurrent Shoulder Instability Recurrent anterior dislocation (RAD) Most common H/O acute dislocation Apprehension test (+ve) Image: Hill Sach s lesion Bankart s lesion

20 Recurrent Shoulder Instability Recurrent anterior dislocation (RAD) Multidirectional instability (MDI) Type RAD MDI Cause Traumatic Atraumatic Clinical feature Apprehension test +ve Sulcus sign positive Treatment Surgery PT

21 Gleno-humeral Joint Disorder Osteoarthritis Rheumatoid TB Milwaukee

movement Wasting the shoulder muscle Tender joint line, Limited ROM

22 Gleno-humeral Osteoarthritis Usually follows other pathology eg. Trauma, rheumatoid artheritis or rc tears Clinical features: Painful movement Wasting the shoulder muscle Tender joint line, Limited ROM X-ray: Loss of joint space Subchondral sclerosis Treatment: Conservative / Replacement

Gleno-humeral Rheumatoid Arthritis Clinical features: Generalized arthritis affecting other joints Pain and limitation of movement Painful

23 Gleno-humeral Rheumatoid Arthritis Clinical features: Generalized arthritis affecting other joints Pain and limitation of movement Painful passive movement and limited active movement Lab investigation: +ve rheumatoid factor X-ray: Loss of articular space Peri-articular erosion

24 Acromioclavicular Disorders Instability Arthritis

25 Sprengel s shoulder: Congenital Scapular Disorders Winging of scapula: Weak serratus ant muscle

26 Shoulder Summary Shoulder Symptoms: Pain Stiffness Instability Deformity Loss of Function Shoulder Examination Look Feel Move Special Tests Investigations Lab X-ray MRI Treatment Conservative Surgical

Shoulder examination. P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College

Shoulder examination. P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College Shoulder examination P Sripathi Rao Arthroscopy & Sports Injuries Unit Dean, Kasturba Medical College Manipal University, Manipal Common symptoms Tingling Numbness Pain Loss of movements Weakness Approach