M. Shane Smith, M.D. Athens Orthopedic Clinic Assistant Professor University of Georgia Health Sciences Center Philadelphia College of Osteopathic Medicine

No Financial Disclosures

Orthopedic Surgeon Sports Medicine Knee, Shoulder, Elbow Surgery Trauma/ Fracture Surgery

Shoulder Pain

“…you have your Ubulus muscle, connects to your Upper Dorsimus “…you have your Ubulus muscle, connects to your Upper Dorsimus. It’s boring, but its part of my life” Ron Burgundy, Anchorman

Shoulder Joint Anatomy

Shoulder Joint Anatomy

Shoulder Pain 5 Most Common Causes Impingement Syndrome Bursitis Subacromial spur Tendon Problem (RC/biceps) Tendonitis (overuse) Tear (traumatic/atraumatic) SLAP tear (overuse) Dislocations/Instability Cartilage/Ligament Problem Labral tear (instability, traumatic) Fracture Usually traumatic Pathologic Arthritis OA, RA, AVN RCT Arthropathy

Shoulder Pain TENDONITIS? BURSITIS? ARTHRITIS? NOT THE SAME PROBLEM!!!

SO, WHATS CAUSING MY PAIN??

Traumatic Injuries

Traumatic Injuries

Atraumatic Injuries

“Other” Injuries

Bursitis Impingement Syndrome Bursae small Excessive use Subacromial spur Bursae small Cushion between bones and the overlying soft tissues Reduces friction between the gliding muscles and the bone Excessive use inflammation and swelling= subacromial bursitis Exam: +Impingement signs; pain with extremes of motion; no weakness

Tendinitis Tendons most commonly affected Acute Chronic A tendon is a cord that connects muscle to bone Tendinitis is inflammation of a tendon Overuse Acute Excessive throwing Repetitive overhead activities (tennis, volleyball, painting,etc) Chronic Degenerative diseases like arthritis or repetitive wear and tear Tendons most commonly affected 4 Rotator cuff tendons Supraspinatus, Infraspinatus, Subscapularis, Teres Minor 1 Bicep tendon (Long head) Exam: Pain with active ROM; Imp signs; Speeds/Yergason Tests;

Tendon Tears Splitting/tearing of tendons Acute injury (sudden) Chronic injury (degenerative, long-term overuse) Partial or complete Rotator cuff (usually supraspinatus) Biceps Exam: RC: Weakness in external rotation/abduction; +drop sign Biceps: +bruising/ecchymosis; +Popeye def

SLAP Tears Superior Labral Anterior Posterior Acute injury (sudden) Chronic injury (degenerative, long-term overuse) Overhead athletes, weight-lifters, weekend warriors Biceps can be involved Exam: Pain with overhead activity; may have mechanical sx +Obrien’s test; +load and shift Biceps sx Dx: MR-Arthrogram

Dislocation/Instability Humeral head dissociates from the glenoid traumatic; most are anterior Can be complete or partially dislocated = subluxation Ligaments/cartilage/capsule around shoulder injured Dislocations/subluxations may recur. Instability increases risk of arthritis Exam: +Apprehension; +Jobes relocation; +sulcus

Arthritis Osteoarthritis ("wear and tear" arthritis) RA, AVN Symptoms swelling, pain, and stiffness develops slowly; pain it worsens over time Patients develop stiff joints/contractures -- Exam: +stiffness, pain on extremes, can be weak if RTA

Fracture Broken bone=fracture=broken bone Fall (elderly) clavicle (collarbone) humerus (upper arm bone) scapula (shoulder blade) Fall (elderly) Traumatic (any age) Younger patients: MVA/sports injury Severe pain, swelling, bruising EXAM: pain; +/- deformity; inability to ROM

Imaging Xrays MRI MR-Arthrogram Ultrasound 3-D CT Scan

What Are My Treatment Options

HEAT AND ICE Ice packs and heat pads are among the most commonly used treatments in orthopedics. Ice treatment is most commonly used for acute injuries. Ice packs can help minimize the swelling around an injury Heat treatment is more commonly used with chronic conditions to help relax and loosen tissues, and to stimulate blood flow to the area.

Injections/Medications Corticosteroids NSAIDS Glucosamine/Chondroitin PRP/Stem Cell Injections (PRCT)

Stretching Stretching the muscles and tendons that surround the joint can help with some causes of shoulder pain. A good routine should be established AVOID ADHESIVE CAPSULITIS!! KEEP SHOULDER MOVING; SLING?

PHYSICAL THERAPY Physical Therapy is an important aspect of treatment of almost all orthopedic conditions ROM, strength, return to sports or healthier level of activity.

Shoulder Arthroscopy Minimally invasive Shoulder joint and subacromial space visualized with a camera Rotator cuff tears Labral pathology (Instability/SLAP) Cartilage damage (OCD, chondromalacia) Technologically advanced surgery

Shoulder Arthroplasty Total shoulder replacement surgery alleviates pain by replacing the damage cartilage and bone with a metal and plastic implant Standard Total Shoulder Replacement (OA, cuff intact) Reverse Total Shoulder (RC arthropathy, severe fracture) Failed conservative treatment

Conclusion 5 Most Common Causes for Shoulder Pain: Tendon tears/tendonitis/SLAP Bursitis/impingement Dislocation/instability Fractures Arthritis Tendonitis, bursitis, and arthritis: NOT THE SAME Fracture = Broken Bone There are lots of great treatments for most shoulder conditions…do not delay While the shoulder anatomy is complex, pretty sure there is no “Ubulus” or “Upper Dorsimus” any where in the human body…

Thank you!!