1. Chronic Shoulder Disorders Dr Mustafa Elsingergy Consultant Orthopedic Surgeon

2. OBJECTIVES  TO KNOW COMMON CAUSES OF SHOULDER PAIN  HOW TO REACH THE DIAGOSIS OF DIFFERENT DISORDERS CLINCALLY  DIFFERENT IMAGING MODALITIES AND THEIR VALUES  MANAGEMENT OF EACH DISORDER

3. Shoulder Pain  INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION  EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

4. Shoulder Pain  INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION  EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

5. Shoulder Pain  INTRINSIC DUE TO CAUSES IN THE SHOULDER REGION  EXTRINSIC DUE TO REFERRED PAIN FROM OUTSIDE THE SHOULDER

6. SHOULDER DISORDERS  DUE TO CAUSES RELATED TO : 1. ROTATOR CUFF (RC) 2. SHOULDER CAPSULE 3. GLENOHUMERAL JOINT (GLJ) 4. SCAPULAR PROBLEMS 5. ACROMIOCLAVICULAR JOINT (ACJ)

7. ROTATOR CUFF  ANATOMY : ORGINATE FROM THE SCAPULA INSERT IN THE GT AND LT PASS UNDER CORACOACROMIAL ARCH SEPARATE FROM THE LIGAMENT BY BURSA

8. ROTATOR CUFF DISORDERS (R.C.D)  ACUTE TENDENITIS  IMPINGEMENT SYNDROME  ROTATOR CUFF TEAR

9. R.C.D ACUTE TENDINITIS  CLINICAL FEATURES PAIN TENDERNESS PAINFUL ABDUCTION RANGE  X-RAY NORMAL AREA OF CALCIFICATION  TREATMENT REST NSAID LOCAL INJECTION

10. R.C.D IMPINGEMENT SYNDROME  CAUSES  CLINICAL FEATURES PAIN SHOULDER LOOKS NORMAL OR WASTED TENDERNESS DISTURBED GLENOHUMERAL RHYTHM PAINFUL ABDUCTION ( 6O TO 120 ) NEER’S TEST (+VE) HAWKIN’S TEST (+VE)

11. R.C.D IMPINGEMENT SYNDROME  XRAY CALCIFICATION DEGENERATED ACJ  MRI BURSITIS THICKENING OF THE TENDON  TREATMENT MILD: NSAID, LOCAL INJECTION SEVERE: ARTHROSCOPY VS ACRMOIOPLASTY

12. R.C.D ROTATOR CUFF TEAR  CAUSES PREDISPOSING FACTOR DEGENERATION: MIDDLE AGE CHRONIC IRRITATION BY OSTEOPHYTE UNDERLYING DISEASE ex. RHEUMATOID PRECEPATATING FACTOR TRAUMA  TYPES: INCOMPLETE COMPLETE

13. R.C.D ROTATOR CUFF TEAR  CLINICAL FEATURES TRAUMA, PAIN, LIMITED ABDUCTIOIN AFTER FEW WEEKS: INCOMPLETE TEAR: IMPROVEMENT OF PAIN AND ROM COMPLETE TEAR: PARTIAL IMPROVEMENT OF PAIN AND DECREASE OF ACTIVE RANGE o LOOK: EARLY; NORMAL APPEARENCE LATE; WASTING OF SUPRASPINATUS AND INFRASPINATUS MUSCLES o FEEL TENDER GREATER TUBEROSITY

14. R.C.D ROTATOR CUFF TEAR  CLINICAL FEATURE: o MOVE: INCOMPLETE TEAR; PAINFUL WEAK COMPLETE; PASSIVE NOT PAINFUL, ACTIVE DROP ARM SIGN IMAGING:  XRAYS: EARLY NORMAL LATE DEGENERATIVE CHANGES  MRI IMAGE OF CHOICE  TREAMENT: INCOMPLETE TEAR: PT, NSA ID COMPLETE TEAR: SURGICAL REPAIR

15. BICEPS TENDON DISORDERS  TENDENITES  PAIN  TENDERNECE: BICEPITAL GROOVE  PIANFUL FORWAD FLEXTION  TREAMENT: NSAID, LOCAL INJECTION  TEAR OF LONG HEAD OF BICEPS TENDON  PAIN  DEFORMITY OF BICEPS CONTOUR ( POPEYE’S ARM)  NO NEED FOR TREAMENT

17. ADHESIVE CAPSULITIS (FROZEN SHOULDER)  UNKNOWN PATHOGENESIS LEADS TO PAIN AND LIMITATION OF MOVEMENT  TRAUMA OR RCD MAY BE CAUSES  CLINICAL FEATURE  PAIN  LIMITATION OF MOVEMENT IN ALL DIRECTIONS OF G-H RANGE  NATURAL HISTORY  PAIN AND LIMITATION OF MOVEMENT GRADUALLY INCREASE THEN GRADUALLY DECREASE, TAKES 18 MONTHS  TREATMENT  CONSERVATIVE VS ARHTROSCOPY

18. RECURRENT SHOULDER INSTABILITY TYPES  RECURRENT ANTERIOR DISLOCATION (RAD)  RECURENT POSTERIOR SUBLUXATION(rare)  MULTIDIRECTIONAL INSTABILITY (MDI)

19. RECURRENT SHOULDER INSTABILITY  RECURRENT ANTERIOR DISLOCATION (RAD): MOST COMMON H/O ACUTE DISLOCATION APPREHENSION TEST (+VE) IMAGE: HILL SACHUS LESION BANKART LESION

20. RECURRENT SHOULDER INSTABILITY MULTIDIRECTIONAL INSTABILITY : GENERALISED LIGAMENTOUS LAXITY SALUCUS SIGN (+VE)

21. RECURRENT SHOULDER INSTABILITY  RECURRENT ANTERIOR DISLOCATION (RAD)  MULTIDIRECTIONAL INSTABILITY (MDI) RADMDI TRAUMATICATRAUMATIC APREHENSIVE TESTSULCUS SIGN POSITIVE SURGICAL TREAMENTPT

23. GLENOHUMERAL JOINT DISORDER  TB  RHEUMATOID  OSTEOARHTERITIS  MIL WAUKEE

24. GLENOHUMERAL RHEUMATOID ARTHERITIS  CLINICAL FEATURE  GENERALIZED ARTHERITIS AFFECTING OTHER JOINTS  PIAN AND LIMITATION OF MOVEMENT  PAINFUL PASSIVE MOVEMENT AND LIMITED ACTIVE MOVEMENT  LAB INVESTIGATION: +VE RHEUMATOID FACTOR  XRAY:  LOSS OF ARTICULAR SPACE  PREARTICULAR EROSION

25. GLENOHUMERAL OSTEOARTHERITIS  USUALLY FOLLOW OTHER PATHOLOGY eg. TRAUMA, RHEUMATOID ARTHERITIS OR RC TEARS  CLINICAL FEATURE  PAINFUL MOVEMENT  WASTING THE SHOULDER MUSCLE  TENDER JOINT LINE  LIMITED ROM  XRAY  LOSS OF JOINT SPACE  SUBCONDIRAL SCHLEROSIS  TREAMENT

26. ACROMIOCLAVICULAR DISORDERS  INSTABBILITY  ARTHERITIS

27. SCAPULAR DISORDERS  SPRENGEL SHOULDER: CONGGENITAL  WINGING OF SCAPULA: WEAK SERRATU ANT MUSCLE

28. Shoulder SUMMARY  Shoulder Symptoms Pain Stiffness Instability Deformity Loss of Function  Shoulder EXAMINATIONS Look Feel Move Special Tests  Investigation Lab Images  Treatment Conservative surgical

29. THANK YOU