Chronic Shoulder Disorders Dr Mustafa Elsingergy Consultant Orthopedic Surgeon

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

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

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

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)

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

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

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

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)

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

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

R.C.D ROTATOR CUFF TEAR  CLINICAL FEATURES TRAUMA, PAIN, LIMITED ABDUCTIOIN AFTER FEW WEEKS: INCOMPLETE TEAR: IMPROVEMENT OF PAIN AND ROM COMPLETE TEAR: 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

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

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

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

RECURRENT SHOULDER INSTABILITY  TYPES  RECURRENT ANTERIOR DISLOCATION (RAD)  RECURENT POSTERIOR SUBLUXATION(rare)  MULTIDIRECTIONAL INSTABILITY (MDI) RADMDI TRAUMATICATRAUMATIC APREHENSIVE TESTSULCUS SIGN POSITIVE SURGICAL TREAMENTPT

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

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

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

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

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

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

ACROMIOCLAVICULAR DISORDERS  INSTABBILITY  ARTHERITIS

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

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

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