Shoulder Problems-1

Shoulder Problems-1 - Shoulder Problems Fractures...

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Unformatted text preview: Shoulder Problems Fractures Instability Impingement Miscellaneous MUN Ortho MUN Anatomy Bones s Joints / Ligaments s Muscles s Neurovascular s MUN Ortho MUN Anatomy MUN Ortho MUN Anatomy Supraspinatus Anterior Posterior MUN Ortho MUN Anatomy MUN Ortho MUN Neurovascular Anatomy MUN Ortho MUN Anatomy:Joints Acromioclavicular s Glenohumeral s Sternoclavicular s “Scapulothoracic” s MUN Ortho MUN Shoulder problems : History Onset,duration,location s ??trauma s radiation of pain s ?C-spine problems s instability,”dead arm” s repetitive use s MUN Ortho MUN Physical Examination deformity eg AC sep’n deformity eg s ROM passive & active s Impingement tests s Instability tests s neurovascular exam s MUN Ortho MUN Shoulder Problems A c u te P a in ? T ra u m a F ra c tu re s N e e r C l a s s if ic a t io n MUN Ortho MUN D is lo c a tio n s AM BRI& TUBS In fla m m a tio n C a lc ific S e p tic Trauma !! MUN Ortho MUN Fractures Clavicle s Proximal Humerus s Scapula / Glenoid s MUN Ortho MUN Clavicle Fractures Common s Most heal uneventfully s Figure of 8 x 6 weeks s Beware of high energy ie MVA s Assoc ‘d soft tissue s MUN Ortho MUN CLAVICLE FRACTURE MUN Ortho MUN Clavicle Fractures : Figure 8 bandage Figure MUN Ortho MUN Proximal Humerus Fractures Neer- 4 parts s Vascularity of articular fragment s Displacement > 1 cm s Angulation > 45 degrees s Xray vs. CT scan s Interobserver variability s MUN Ortho MUN Fractures : The Four Parts Fractures MUN Ortho MUN Fractures MUN Ortho MUN Proximal Humerus Fractures Treatment Undisplaced & 2-part : Sling s 3- part : ORIF s 4- part : Prosthesis 4s MUN Ortho MUN 4 PART FRACTURE PART MUN Ortho MUN NEER PROSTHESIS NEER MUN Ortho MUN 3 PART FRACTURE MUN Ortho MUN ORIF 3 PART MUN Ortho MUN Fractures :Scapula / Glenoid Rare s Most treated conservatively s Intraarticular displacement may need Intraarticular ORIF ORIF s MUN Ortho MUN Shoulder Instability Traumatic vs. Habitual s Unidirectional vs. Multidirectional s Unilateral vs. Bilateral s MUN Ortho MUN Anterior Shoulder Instabliity Hx of significant trauma s Very Painful s Most common s Nerve injury esp. axillary Nerve esp. s Xray : Hill-Sachs defect s MUN Ortho MUN The “Y” lateral Xray MUN Ortho MUN The “Y” lateral Xray MUN Ortho MUN Bankart and Hill-Sach’s lesions MUN Ortho MUN Anterior Shoulder Instability Needs urgent reduction s Muscle relaxation,traction,patience s Post reduction exam(neuro) & Xray s Gilchrist sling s Tell patient recurrence risk s recurrent dislocation requires surgery s MUN Ortho MUN Anterior dislocation ;reduction MUN Ortho MUN Anterior Shoulder Instability Surgery involves repair of torn anterior Surgery structures structures s Bankart lesion s High success rate with several different High procedures procedures s MUN Ortho MUN Anterior Shoulder Instability Traumatic s Unidirectional s Bankart s Surgery s MUN Ortho MUN Multidirectional Instability anterior,posterior,inferior s voluntary s atraumatic s ligament laxity s some are assoc’d with psychological some problems problems s MUN Ortho MUN Multidirectional Instability Atraumatic s Multidirectional s Bilateral s Rehabilitation s Inferior Capsular Shift (RARELY) s MUN Ortho MUN Acromioclavicular Separations Hockey , bikes s Coracoclavicular & Acromioclavicular Coracoclavicular ligaments ligaments s Grade 1-6 s Most treated conservatively s Late excision of outer end of clavicle s MUN Ortho MUN The Clavicular Ligaments MUN Ortho MUN Acromioclavicular Ligaments MUN Ortho MUN MUN Ortho MUN Inflammation:Calcific Tendonitis Acute occ. severe pain s Mimics infection s Marked decrease ROM s Xray : Fluffy density near greater Xray tuberosity tuberosity s NSAIDS s MUN Ortho MUN Calcific Tendonitis MUN Ortho MUN Inflammation Septic s Gout s RA flare-up s MUN Ortho MUN Shoulder Pain : Chronic C h r o n ic S h o u ld e r P a in Im p in g e m e n t S y n d ro m e s R o ta to r c u ff te n d o n itis c u ff te a r s A C a r th r itis MUN Ortho MUN O s te o a r th r itis R h e u m a to id A r th r itis AVN F r o z e n S h o u ld e r B e n ig n tu m o r s M a lig n a n t tu m o r s p r im a r y s e c o n d a ry Impingement Syndromes Subacromial bursitis s Rotator cuff tendonitis s Bicipital tendonitis s AC arthritis s Rotator cuff tear s MUN Ortho MUN Impnigement : Anatomy MUN Ortho MUN Acromion Morphology MUN Ortho MUN Impingement : Supraspinatus MUN Ortho MUN Impingement :Hx & Px Repetitive overhead use of arm s Swimmers,pitchers s painful arc s impingement signs s decreased ROM active vs. passive s pain with resisted motion pain s MUN Ortho MUN Impingement : treatment Avoidance of offending activity s Physiotherapy s NSAIDS s Corticosteroid injection s Surgery : Subacromial decompression s MUN Ortho MUN Impingement : Imaging Xrays : often normal s Xrays : shape of acromion s Arthrogram s MRI s MSK Ultrasound MSK s MUN Ortho MUN MRI ROTATOR CUFF MRI MUN Ortho MUN Impingement :Surgery Arthroscopic vs open decompression s Cuff repair s Excision outer end of clavicle Excision s MUN Ortho MUN Impingement : Acromioplasty MUN Ortho MUN Rotator Cuff Repair MUN Ortho MUN Frozen Shoulder primary vs. secondary s prolonged stiffness s usually self-limited s lasts up to 2 years s physio/injection manipulation s benign neglect s MUN Ortho MUN RA Shoulder usually obvious diagnosis s joint and tendon damage s steroid injections s synovectomy s Total shoulder arthroplasty s MUN Ortho MUN OA & AVN uncommon s end stage can be treated by end arthroplasty arthroplasty s AVN risk factors s MUN Ortho MUN OA SHOULDER OA SHOULDER MUN Ortho MUN Tumors primary relatively rare s always think of metastatic disease in always patients > 50 patients s night pain s Xray : bone destruction s MUN Ortho MUN Tumors MUN Ortho MUN ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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