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Chronic Shoulder Disorders

Chronic Shoulder Disorders. Dr Mustafa Elsingergy Consultant Orthopedic Surgeon. 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. Shoulder Pain.

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Chronic Shoulder Disorders

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  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 : • 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.DACUTE TENDINITIS • CLINICAL FEATURES PAIN TENDERNESS PAINFUL ABDUCTION RANGE • X-RAY NORMAL AREA OF CALCIFICATION • TREATMENT REST NSAID LOCAL INJECTION

  10. R.C.DIMPINGEMENT 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.DIMPINGEMENT SYNDROME • XRAY • CALCIFICATION • DEGENERATED ACJ • MRI • BURSITIS • THICKENING OF THE TENDON • TREATMENT • MILD: NSAID, LOCAL INJECTION • SEVERE: ARTHROSCOPYVS ACRMOIOPLASTY

  12. R.C.DROTATOR 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.DROTATOR 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 • LOOK: EARLY; NORMAL APPEARENCE LATE; WASTING OF SUPRASPINATUS AND INFRASPINATUS MUSCLES • FEEL TENDER GREATER TUBEROSITY

  14. R.C.DROTATOR CUFF TEAR • CLINICAL FEATURE: • 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

  16. 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 MOVEMENTGRADUALLY INCREASE THEN GRADUALLY DECREASE, TAKES 18 MONTHS • TREATMENT • CONSERVATIVE VS ARHTROSCOPY

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

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

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

  20. RECURRENT SHOULDER INSTABILITY • RECURRENT ANTERIOR DISLOCATION (RAD) • MULTIDIRECTIONAL INSTABILITY (MDI)

  21. GLENOHUMERAL JOINT DISORDER • TB • RHEUMATOID • OSTEOARHTERITIS • MIL WAUKEE

  22. 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

  23. 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

  24. ACROMIOCLAVICULAR DISORDERS • INSTABBILITY • ARTHERITIS

  25. SCAPULAR DISORDERS • SPRENGEL SHOULDER: CONGGENITAL • WINGING OF SCAPULA: WEAK SERRATU ANT MUSCLE

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

  27. THANK YOU

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