Chronic Shoulder Disorders Dr Mustafa Elsingergy Consultant Orthopedic Surgeon.
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Transcript of Chronic Shoulder Disorders Dr Mustafa Elsingergy Consultant Orthopedic Surgeon.
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.DACUTE TENDINITIS
CLINICAL FEATURES
PAIN
TENDERNESS
PAINFUL ABDUCTION RANGE
X-RAY
NORMAL
AREA OF CALCIFICATION
TREATMENT
REST
NSAID
LOCAL INJECTION
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)
R.C.DIMPINGEMENT SYNDROME
XRAY
• CALCIFICATION
• DEGENERATED ACJ
MRI
• BURSITIS
• THICKENING OF THE TENDON
TREATMENT
• MILD: NSAID, LOCAL INJECTION
• SEVERE: ARTHROSCOPY VS ACRMOIOPLASTY
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
R.C.DROTATOR 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.DROTATOR 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)
RAD MDI
TRAUMATIC ATRAUMATIC
APREHENSIVE TEST SULCUS SIGN POSITIVE
SURGICAL TREAMENT PT
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)
RAD MDI
TRAUMATIC ATRAUMATIC
APREHENSIVE TEST SULCUS SIGN POSITIVE
SURGICAL TREAMENT PT
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 SymptomsPainStiffnessInstabilityDeformityLoss of Function
Shoulder EXAMINATIONSLookFeelMoveSpecial Tests
InvestigationLabImages
Treatment Conservative surgical
THANK YOU