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

2. No Financial Disclosures

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

4. Shoulder Pain

5. “…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

6. Shoulder Joint Anatomy

7. Shoulder Joint Anatomy

8. 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

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

10. SO, WHATS CAUSING MY PAIN??

11. Traumatic Injuries

12. Traumatic Injuries

13. Atraumatic Injuries

14. “Other” Injuries

15. 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

16. 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;

17. 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

18. 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

19. 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

20. 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

21. 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

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

23. What Are My Treatment Options

24. 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.

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

26. 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?

27. 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.

28. 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

29. 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

30. 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…

31. Thank you!!