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Anatomy Case Correlate“Shoulder Pain”
History 22 year old male, professional hockey player6 week history of right shoulder pain No recent trauma Training heavily in the off-season Upper arm pain, increased with overhead activity, lifting
Physical Exam Normal motion Pain with lifting beyond 90 degreesAbduction 4+/5 and painful External rotation 4/5 Infraspinatus atrophy
Differential Rotator cuff Cervical spine Instability Nerve entrapmentLabral tear Arthritis
Differential Inflammatory Tumor Infection Fracture Adhesive CapsulitisIntrathoracic Biceps
Rotator Cuff Impingement“Dynamic” pinching of the supraspinatus tendon between the humeral head and undersurface of acromion Force couple between deltoid and rotator cuff musculature
Rotator Cuff Disease Inflammatory Degeneration Partial TearingFull Thickness Tearing Tears predictably begin in supraspinatus Part of normal aging process
Instability Static restraints Dynamic restraints (musculature)Osseous architecture Capsuloligamentous restraints Dynamic restraints (musculature)
Shoulder Instability Dislocation Subluxation More difficult diagnosisSuspect in younger patient with chronic post-traumatic shoulder pain, with or without history of instabilty
AC JOINT Traumatic event (separation)Arthritis (post-traumatic versus degenerative) Well localized pain, superior shoulder
Labral Tear Variable anatomySLAP lesion (superior, labrum, anterior and posterior) Most common in repetitive overhead athletes
Approaching the ProblemSubjective complaints cuff tendinitis Abduction pain cuff tendinitis No history of instability Pain not localized to AC joint No repetitive overhead sports
Approaching the ProblemBut, infraspinatus atrophy and external rotation weakness Massive rotator cuff tear Suprascapular neuropathy
Suprascapular Nerve Origin: C5 root or upper trunk of brachial plexusSuprascapular notch, beneath transverse scapular ligament Innervates supraspinatus Winds around spine of scapula Innervates infraspinatus
Further Work-up X-rays normalElectrodiagnostic studies injury to suprascapular nerve at spinoglenoid notch isolated denervation of infraspinatus Ganglion cyst?
Diagnosis Suprascapular neuropathy right shoulder secondary to ganglion cyst with possible superior labral tear at spinoglenoid notch
Treatment Right shoulder arthroscopyLabral debridement, arthroscopic decompression of the cyst Post op rehab, return to play at 6 weeks with full strength
Suprascapular NeuropathyIt all starts with the anatomy Careful history + careful exam usually results in diagnosis Imaging studies, when necessary, support what you suspect from above
Ch. 21 Shoulder Injuries. Impingement Syndrome Space between humeral head below and acromion above becomes narrowed The structures that live in that space.
1 Douglas Carlan, MD Hand and Upper Extremity Eaton Orthopaedics, LLC Carillon Outpatient Center Overcoming Rotator Cuff Injuries.
The Shoulder & Pectoral Girdle (2). Imaging X-ray shows sublaxation, dislocation, narrow joint space, bone erosion, calcification in soft tissues Arthrography.
Physical Evaluation of the shoulder By Beverly Nelson.
Differential diagnosis of nerve pathologies in the shoulder Sumit Bassi M.D. Sports Medicine Fellow Summa Health.
Superior Labral Anterior to Posterior (SLAP) Tears Thomas J Kovack DO.
BELLWORK LAST CHAPTER!!!!!!!!!! In your opinion:
In the name of GOD Sheikhlotfolah mosque Isfahan.
FUNCTIONAL ANATOMY OF THE SHOULDER AND UPPER ARM
Long Head of Biceps Pathology Tendinopathy and Instability.
© 2010 Delmar, Cengage Learning 1 © 2011 Delmar, Cengage Learning PowerPoint Presentation to Accompany.
ANATOMY OF THE SHOULDER REGION
History & Physical Examination of the Shoulder
Dr Jamila EL Medany. OBJECTIVESOBJECTIVES At the end of the lecture, students should: the name List the name of muscles of the shoulder region. attachments.
Anatomy of Shoulder Part 2
Injuries to the Shoulder. Brief Epidemiology Shoulder pain: a common complaint in primary care –2 nd only to knee pain for specialist referrals –Most.
Orthopaedics in Primary Care The Shoulder Andrew Pearse Worcestershire Acute Hospitals.
Injuries to the Shoulder
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MODULE 4 SHOULDER.
BY DR LC MULUNGWA 10 SEPTEMBER 2011
In The Name of GOD.
Shoulder pain Dr Shrenik Shah. Overview Anatomy Clinico-patho-radio correlation How to manage day to day shoulder problems? Promising modality - RSWT.
Kristine A. Karlson, MD Dartmouth Medical School Community and Family Medicine/ Orthopaedics Physical Examination of the Shoulder.
GP PLS Session Shoulder and Elbow Shoulder and Elbow Thursday 26th May 2016 Helen Patten SMSKP Extended Scope Physiotherapist.
Suprascapular Neuropathy by Robert E. Boykin, Darren J. Friedman, Laurence D. Higgins, and Jon J.P. Warner J Bone Joint Surg Am Volume 92(13):
Shoulder Anatomy. Shoulder It is a ball and socket joint that moves in all three planes and has: Most mobile and least stable joint.
Jean Mc Feely M.Sc, C.S.C.S.1 Healthy Shoulders Presented by Jean Mc Feely M.Sc., C.S.C.S. Brockville & Area YMCA.
The shoulder Chapter 21.
Orthopedic Management of the Shoulder
Shoulder Orthopedic Tests
Posterior Capsule Tightness Common problem of throwers and racket sport players Especially seen in pitchers Prevented with posterior capsule stretches.
Shoulder Complex Injuries
Mr. Nnamdi Obi Specialist registrar United Kingdom
The Shoulder. Shoulder Girdle Complex There are three primary articulations Glenohumeral joint Glenohumeral joint Aromioclavicular joint Aromioclavicular.
SLAP Tears By Kale, Tanner, Logan, Adrien. Objectives What is a SLAP tear What causes a SLAP tear What are the surgical procedures for a SLAP Tear Rehabilitation.
Basics Of MRI:How I Do It AFIIM -ISRA 2015 QUIZ 3: Shoulder Imaging.
Injuries to the Shoulder Region
Guide to Diagnosis and Conservative Treatment
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