shoulder pain impingement l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Shoulder Pain/Impingement PowerPoint Presentation
Download Presentation
Shoulder Pain/Impingement

Loading in 2 Seconds...

play fullscreen
1 / 20

Shoulder Pain/Impingement - PowerPoint PPT Presentation


  • 352 Views
  • Uploaded on

Shoulder Pain/Impingement. Matthew E. Mitchell M.D. Disclaimer.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Shoulder Pain/Impingement' - Rita


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
shoulder pain impingement

Shoulder Pain/Impingement

Matthew E. Mitchell M.D.

disclaimer
Disclaimer
  • Patients should discuss specific injuries with their primary care doctor or surgeon. This site is meant to give general information to patients about specific patient problems. It is impossible to individualize this discussion to specific patient issues.

mattmitchellmd.com

shoulder pain
Shoulder Pain
  • Many conditions cause shoulder pain
  • Extra Articular pain “outside of the joint”
    • AC (acromial clavicular) joint pain
    • Impingement or “bursitis”
    • Rotator Cuff Tear
  • Intra articular pain “inside the joint”
    • Arthritis
    • Cartilage injury
    • Loose bodies

mattmitchellmd.com

extra articular
Extra-articular
  • Impingement or bursitis
    • Inflammation of bursa or “sac” in subacromial space
  • Symptoms
    • Crepitus which patients call “popping” “crunching” in shoulder
    • Pain with overhead activity
    • Pain localized on apex of shoulder

mattmitchellmd.com

anatomy
Anatomy

AC joint

Clavicle

Acromion

Bursa: Location of “Bursitis”

Rotator Cuff Underneath Bursa

Humerus

mattmitchellmd.com

treatment of impingement
Treatment of Impingement
  • Physical Therapy
    • Regain range of motion
    • Start strengthening
  • Injections
    • Caution in young people
    • Toxic to cartilage
    • Limit injections to 3 or less
  • Surgery
    • Arthroscopic decompression
    • Shave piece of bone and remove inflamed bursa

mattmitchellmd.com

results of treatment
Results of Treatment
  • Most patients get better with physical therapy and modifications to activity in 6 months
  • Surgery has good results when people have had a favorable response to injections

mattmitchellmd.com

ac or acromio clavicular pain
AC or Acromio-clavicular Pain
  • Pain located in the joint that connects the acromion and clavicle
  • Symptoms
    • Pain located in the mid clavicle or “collar bone” area
    • Sometimes occurs in weight lifters
    • Can also exist with impingment or “bursitis”

mattmitchellmd.com

anatomy9
Anatomy

AC joint: location of AC pain

Clavicle

Acromion

Bursa: Location of “Bursitis”

Rotator Cuff Underneath Bursa

Humerus

mattmitchellmd.com

ac pain treatment
AC Pain Treatment
  • Physical Therapy
    • Regain range of motion
    • Start strengthening
  • Injections
    • Caution in young people
    • Toxic to cartilage
    • Limit injections to 3 or less
  • Surgery
    • Arthroscopic decompression
    • Shave part of joint out

mattmitchellmd.com

results of treatment11
Results of Treatment
  • Physical therapy can be beneficial if “bursitis” or impingement is also present
  • Injections can give very good relief of pain
  • Surgery has high predictive success if

injections temporarily relieve pain

mattmitchellmd.com

rotator cuff tear
Rotator Cuff Tear
  • Tear of the small muscles around the shoulder
  • Symptoms
    • Pain with overhead activity
    • Weakness
    • Pain on apex of shoulder
    • More common in people over 40 years old

mattmitchellmd.com

anatomy13
Anatomy

Rotator Cuff

Muscle “Covers” the Shoulder Like a Cuff

mattmitchellmd.com

treatment
Treatment
  • Treatment depends on symptoms and age of patient
  • Young patients with tears should probably have early repair even if symptoms are not severe
  • Middle age patients 40-60 years old should be trialed with non-operative treatment but
  • enlargement of tear and arthritis is a possibility
  • Older patients with large tears can be treated with injections and non-operative treatment

mattmitchellmd.com

results of treament
Results of Treament
  • Very large tears are difficult to treat
  • In older patients pain is reliably relieved but

strength may not be improved with surgery

  • In younger patients some improvement in strength may be possible with surgery

mattmitchellmd.com

intra articular pain
Intra-articular Pain
  • Cartilage Injury
    • Labrum (surrounds the articular cartilage)
    • Arthritis (articular cartilage)
  • Symptoms
    • Dislocations
    • Throwing pain
    • Loss of strength

mattmitchellmd.com

intra articular pain17
Intra-articular Pain

Arthritis: articular cartilage

Superior Labral Tears: throwing pain

Inferior Labral Tears: instability and dislocation

mattmitchellmd.com

treatment18
Treatment
  • Physical Therapy
    • Range of motion
    • Strengthening
  • Injections
    • Used to help with diagnosis
  • Surgery
    • Arthroscopic repair of labral injury
    • Tighten capsule if necessary

mattmitchellmd.com

results
Results
  • Arthroscopic repair of labral injuries
    • Good results with accurate diagnosis
  • Arthroscopic treatment of dislocation
    • It has results equal to open repair but these reports are early
    • There may be a role for early repair in young active people

mattmitchellmd.com

summary
Summary
  • Shoulder pain has intra-articular and extra-articular causes
  • Burisitis or impingement is most common extra-articular cause
  • The main initial treatment is physical therapy and activity modification
  • Surgery has good results in most cases

Back to Patient Information

mattmitchellmd.com