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Shoulder Problems. Fractures Instability Impingement Miscellaneous. Anatomy. Bones Joints / Ligaments Muscles Neurovascular. Anatomy. Anatomy. Supraspinatus. Anterior. Posterior. Anatomy. Neurovascular Anatomy. Anatomy:Joints. Acromioclavicular Glenohumeral Sternoclavicular

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shoulder problems

Shoulder Problems

Fractures

Instability

Impingement

Miscellaneous

anatomy
Anatomy
  • Bones
  • Joints / Ligaments
  • Muscles
  • Neurovascular
anatomy4
Anatomy

Supraspinatus

Anterior

Posterior

anatomy joints
Anatomy:Joints
  • Acromioclavicular
  • Glenohumeral
  • Sternoclavicular
  • “Scapulothoracic”
shoulder problems history
Shoulder problems : History
  • Onset,duration,location
  • ??trauma
  • radiation of pain
  • ?C-spine problems
  • instability,”dead arm”
  • repetitive use
physical examination
Physical Examination
  • deformity eg AC sep’n
  • ROM passive & active
  • Impingement tests
  • Instability tests
  • neurovascular exam
fractures
Fractures
  • Clavicle
  • Proximal Humerus
  • Scapula / Glenoid
clavicle fractures
Clavicle Fractures
  • Common
  • Most heal uneventfully
  • Figure of 8 x 6 weeks
  • Beware of high energy ie MVA
  • Assoc ‘d soft tissue
proximal humerus fractures
Proximal Humerus Fractures
  • Neer- 4 parts
  • Vascularity of articular fragment
  • Displacement > 1 cm
  • Angulation > 45 degrees
  • Xray vs. CT scan
  • Interobserver variability
proximal humerus fractures treatment
Proximal Humerus FracturesTreatment
  • Undisplaced & 2-part : Sling
  • 3- part : ORIF
  • 4- part : Prosthesis
fractures scapula glenoid
Fractures :Scapula / Glenoid
  • Rare
  • Most treated conservatively
  • Intraarticular displacement may need ORIF
shoulder instability
Shoulder Instability
  • Traumatic vs. Habitual
  • Unidirectional vs. Multidirectional
  • Unilateral vs. Bilateral
anterior shoulder instabliity
Anterior Shoulder Instabliity
  • Hx of significant trauma
  • Very Painful
  • Most common
  • Nerve injury esp. axillary
  • Xray : Hill-Sachs defect
anterior shoulder instability
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
anterior shoulder instability32
Anterior Shoulder Instability
  • Surgery involves repair of torn anterior structures
  • Bankart lesion
  • High success rate with several different procedures
anterior shoulder instability33
Anterior Shoulder Instability
  • Traumatic
  • Unidirectional
  • Bankart
  • Surgery
multidirectional instability
Multidirectional Instability
  • anterior,posterior,inferior
  • voluntary
  • atraumatic
  • ligament laxity
  • some are assoc’d with psychological problems
multidirectional instability35
Multidirectional Instability
  • Atraumatic
  • Multidirectional
  • Bilateral
  • Rehabilitation
  • Inferior Capsular Shift (RARELY)
acromioclavicular separations
Acromioclavicular Separations
  • Hockey , bikes
  • Coracoclavicular & Acromioclavicular ligaments
  • Grade 1-6
  • Most treated conservatively
  • Late excision of outer end of clavicle
inflammation calcific tendonitis
Inflammation:Calcific Tendonitis
  • Acute occ. severe pain
  • Mimics infection
  • Marked decrease ROM
  • Xray : Fluffy density near greater tuberosity
  • NSAIDS
inflammation
Inflammation
  • Septic
  • Gout
  • RA flare-up
impingement syndromes
Impingement Syndromes
  • Subacromial bursitis
  • Rotator cuff tendonitis
  • Bicipital tendonitis
  • AC arthritis
  • Rotator cuff tear
impingement hx px
Impingement :Hx & Px
  • Repetitive overhead use of arm
  • Swimmers,pitchers
  • painful arc
  • impingement signs
  • decreased ROM active vs. passive
  • pain with resisted motion
impingement treatment
Impingement : treatment
  • Avoidance of offending activity
  • Physiotherapy
  • NSAIDS
  • Corticosteroid injection
  • Surgery : Subacromial decompression
impingement imaging
Impingement : Imaging
  • Xrays : often normal
  • Xrays : shape of acromion
  • Arthrogram
  • MRI
  • MSK Ultrasound
impingement surgery
Impingement :Surgery
  • Arthroscopic vs open decompression
  • Cuff repair
  • Excision outer end of clavicle
frozen shoulder
Frozen Shoulder
  • primary vs. secondary
  • prolonged stiffness
  • usually self-limited
  • lasts up to 2 years
  • physio/injection manipulation
  • benign neglect
ra shoulder
RA Shoulder
  • usually obvious diagnosis
  • joint and tendon damage
  • steroid injections
  • synovectomy
  • Total shoulder arthroplasty
oa avn
OA & AVN
  • uncommon
  • end stage can be treated by arthroplasty
  • AVN risk factors
tumors
Tumors
  • primary relatively rare
  • always think of metastatic disease in patients > 50
  • night pain
  • Xray : bone destruction