6 Prevalence Prevalence of shoulder pain - adults 7% overall26% in elderlyOnly 20-50% present to primary care1% of primary care consultations20% referred to secondary careOver 50% only 1 consultationRheumatology 2006;45:215–221
17 Supraspinatus- Apley's Scratch Test - Jobes Supraspinatus test - Dawburn's sign - Sherry Party sign - Codman's Sign (Drop Arm Sign) - Rent Test - Zero Degree Abduction Test - Burkhead's Thumbs down & Burkhead's Thumbs up
23 Differential by age < 20 years 20 – 40 years > 40 years InstabilityTraumaLabral pathologyBiceps pathologyTendonitisFrozen shoulderRotator cuff dzOsteoarthritisTumor
24 Shoulder history General Specific Instability Rotator cuff and ACJ Age, dominance, occupation, hobbiesGeneral healthSpecificPain – sleep, night painWeaknessStiffnessRx so farInstabilityRotator cuff and ACJArthritis
53 …….. Perhaps this patient needs an MRI scan 60-69 =30% FTRCT70-79 = 50% FTRCT80-89 = 80% FTRCTAge-related prevalence of rotator cuff tears in asymptomatic shoulders; Tempelhof et al; JSES July 1999 (Vol. 8, Issue 4, Pg
54 104 shoulders chronic, atraumatic shoulder pain History, physical examination, radiographs41% had pre evaluation MRI scansMajority of pre-evaluation MRI scans had no impact on the outcome90% no valueRoutine pre-evaluation with MRI does not appear to have a significant effect on the treatment or outcomeJSES 2005;14:
55 MRI Atypical Mechanical integrity Rarities Previously prior to surgery Although it hurts your coming to no harmRaritiesPreviously prior to surgeryALL rotator cuffs arthroscopically
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