Presentation is loading. Please wait.

Presentation is loading. Please wait.

Anatomy Case Correlate

Similar presentations

Presentation on theme: "Anatomy Case Correlate"— Presentation transcript:

1 Anatomy Case Correlate
“Shoulder Pain”

2 History 22 year old male, professional hockey player
6 week history of right shoulder pain No recent trauma Training heavily in the off-season Upper arm pain, increased with overhead activity, lifting

3 Physical Exam Normal motion Pain with lifting beyond 90 degrees
Abduction 4+/5 and painful External rotation 4/5 Infraspinatus atrophy

4 Differential Rotator cuff Cervical spine Instability Nerve entrapment
Labral tear Arthritis

5 Differential Inflammatory Tumor Infection Fracture Adhesive Capsulitis
Intrathoracic Biceps

6 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


8 Rotator Cuff Disease Inflammatory Degeneration Partial Tearing
Full Thickness Tearing Tears predictably begin in supraspinatus Part of normal aging process

9 Instability Static restraints Dynamic restraints (musculature)
Osseous architecture Capsuloligamentous restraints Dynamic restraints (musculature)

10 Shoulder Instability Dislocation Subluxation More difficult diagnosis
Suspect in younger patient with chronic post-traumatic shoulder pain, with or without history of instabilty

11 AC JOINT Traumatic event (separation)
Arthritis (post-traumatic versus degenerative) Well localized pain, superior shoulder

12 Labral Tear Variable anatomy
SLAP lesion (superior, labrum, anterior and posterior) Most common in repetitive overhead athletes


14 Approaching the Problem
Subjective complaints  cuff tendinitis Abduction pain  cuff tendinitis No history of instability Pain not localized to AC joint No repetitive overhead sports


16 Approaching the Problem
But, infraspinatus atrophy and external rotation weakness Massive rotator cuff tear Suprascapular neuropathy

17 Suprascapular Nerve Origin: C5 root or upper trunk of brachial plexus
Suprascapular notch, beneath transverse scapular ligament Innervates supraspinatus Winds around spine of scapula Innervates infraspinatus

18 Further Work-up X-rays normal
Electrodiagnostic studies  injury to suprascapular nerve at spinoglenoid notch  isolated denervation of infraspinatus Ganglion cyst?


20 Diagnosis Suprascapular neuropathy right shoulder secondary to ganglion cyst with possible superior labral tear at spinoglenoid notch

21 Treatment Right shoulder arthroscopy
Labral debridement, arthroscopic decompression of the cyst Post op rehab, return to play at 6 weeks with full strength

22 Suprascapular Neuropathy
It all starts with the anatomy Careful history + careful exam usually results in diagnosis Imaging studies, when necessary, support what you suspect from above



Download ppt "Anatomy Case Correlate"

Similar presentations

Ads by Google