1 / 24

Anatomy Case Correlate

Anatomy Case Correlate. “Shoulder Pain”. 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. Physical Exam. Normal motion

dmitri
Download Presentation

Anatomy Case Correlate

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

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

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

  8. Instability • Static restraints • Osseous architecture • Capsuloligamentous restraints • Dynamic restraints (musculature)

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

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

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

  12. 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

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

  14. 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

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

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

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

  18. 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

More Related