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1 Shoulder Problems Fractures Instability Impingement Miscellaneous
2 Anatomy Bones Joints / Ligaments Muscles Neurovascular
3 Anatomy
4 Anatomy Supraspinatus Anterior Posterior
5 Anatomy
6 Neurovascular Anatomy
7 Anatomy:Joints Acromioclavicular Glenohumeral Sternoclavicular Scapulothoracic
8 Shoulder problems : History Onset,duration,location??trauma radiation of pain?c-spine problems instability, dead arm repetitive use
9 Physical Examination deformity eg AC sep n ROM passive & active Impingement tests Instability tests neurovascular exam
10 Shoulder Problems Acute Pain? Trauma Fractures Neer Classification Dislocations AMBRI & TUBS Inflammation Calcific Septic
11 Trauma!!
12 Fractures Clavicle Proximal Humerus Scapula / Glenoid
13 Clavicle Fractures Common Most heal uneventfully Figure of 8 x 6 weeks Beware of high energy ie MVA Assoc d d soft tissue
14 CLAVICLE FRACTURE
15 Clavicle Fractures : Figure 8 bandage
16 Proximal Humerus Fractures Neer- 4 parts Vascularity of articular fragment Displacement > 1 cm Angulation > 45 degrees Xray vs. CT scan Interobserver variability
17 Fractures : The Four Parts
18 Fractures
19 Proximal Humerus Fractures Treatment Undisplaced & 2-part 2 : Sling 3- part : ORIF 4- part : Prosthesis
20 4 PART FRACTURE
21 NEER PROSTHESIS
22 3 PART FRACTURE
23 ORIF 3 PART
24 Fractures :Scapula / Glenoid Rare Most treated conservatively Intraarticular displacement may need ORIF
25 Shoulder Instability Traumatic vs. Habitual Unidirectional vs. Multidirectional Unilateral vs. Bilateral
26 Anterior Shoulder Instabliity Hx of significant trauma Very Painful Most common Nerve injury esp. axillary Xray : Hill-Sachs defect
27 The Y lateral Xray
28 The Y lateral Xray
29 Bankart and Hill-Sach Sach s lesions
30 Anterior Shoulder Instability Needs urgent reduction Muscle relaxation,traction,patience Post reduction exam(neuro) ) & Xray Gilchrist sling Tell patient recurrence risk recurrent dislocation requires surgery
31 Anterior dislocation ;reduction
32 Anterior Shoulder Instability Surgery involves repair of torn anterior structures Bankart lesion High success rate with several different procedures
33 Anterior Shoulder Instability Traumatic Unidirectional Bankart Surgery
34 Multidirectional Instability anterior,posterior,inferior voluntary atraumatic ligament laxity some are assoc d with psychological problems
35 Multidirectional Instability Atraumatic Multidirectional Bilateral Rehabilitation Inferior Capsular Shift (RARELY)
36 Acromioclavicular Separations Hockey, bikes Coracoclavicular & Acromioclavicular ligaments Grade 1-61 Most treated conservatively Late excision of outer end of clavicle
37 The Clavicular Ligaments
38 Acromioclavicular Ligaments
39
40 Inflammation:Calcific Tendonitis Acute occ. severe pain Mimics infection Marked decrease ROM Xray : Fluffy density near greater tuberosity NSAIDS
41 Calcific Tendonitis
42 Inflammation Septic Gout RA flare-up
43 Shoulder Pain : Chronic Chronic Shoulder Pain Impingement Syndromes Rotator cuff tendonitis cuff tears AC arthritis Osteoarthritis Rheumatoid Arthritis AVN Frozen Shoulder Benign tumors Malignant tumors primary secondary
44 Impingement Syndromes Subacromial bursitis Rotator cuff tendonitis Bicipital tendonitis AC arthritis Rotator cuff tear
45 Impnigement : Anatomy
46 Acromion Morphology
47 Impingement : Supraspinatus
48 Impingement :Hx & Px Repetitive overhead use of arm Swimmers,pitchers painful arc impingement signs decreased ROM active vs. passive pain with resisted motion
49 Impingement : treatment Avoidance of offending activity Physiotherapy NSAIDS Corticosteroid injection Surgery : Subacromial decompression
50 Impingement : Imaging Xrays : often normal Xrays : shape of acromion Arthrogram MRI MSK Ultrasound
51 MRI ROTATOR CUFF
52 Impingement :Surgery Arthroscopic vs open decompression Cuff repair Excision outer end of clavicle
53 Impingement : Acromioplasty
54 Rotator Cuff Repair
55 Frozen Shoulder primary vs. secondary prolonged stiffness usually self-limited limited lasts up to 2 years physio/injection manipulation benign neglect
56 RA Shoulder usually obvious diagnosis joint and tendon damage steroid injections synovectomy Total shoulder arthroplasty
57 OA & AVN uncommon end stage can be treated by arthroplasty AVN risk factors
58 OA SHOULDER
59 Tumors primary relatively rare always think of metastatic disease in patients > 50 night pain Xray : bone destruction
60 Tumors
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