Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF...

Dr Jerome GoldbergShoulder Surgery

ASSESSMENT OF THE STIFF

SHOULDER

Dr Jerome Goldberg

www.orthosports.com.au

DEFINITION

Loss of

• active movment &

• passive movement

• 55 yr old lady

• Housewife

• No trauma

• Family history NIDDM

• 3 month history of

increasing lateral arm

and night pain

• Noticed loss of ROM

over last 6 weeks

• Active elevation 90

• IR to sacrum

• Power normal

• Passive elevation 90

• ER 0

WHAT INVESTIGATIONS SHOULD WE ORDER?

A. Xray

B. Utlrasound

C. MRI or MRA

D. A & B

E. A & C

WHAT IS THE DIAGNOSIS?

A. Adhesive Capsulitis

B. Osteoarthritis

C. Locked posterior dislocation

D. Tumour

E. None of the above

CAUSES

• Adhesive capsulitis

• Osteoarthritis

• Post operative

• Dislocations – mainly the

locked posterior

dislocation

• tumour

• Hysterical

shoulder/compensation

HISTORY

• Age

• Hand dominance

• Occupation

• Recreational activities

• Sports

• Previous shoulder ops

• Medical history

– Arthritis

– Diabetes/thyroid

• Family history

HISTORY

• Trauma

• Length of symptoms

• Location of pain

• exacerbating and relieving

factors

• Night discomfort

• Loss of movement

• Loss of power

• Neurological symptoms

HISTORY

Beware of

• Rest pain

• Constant pain

• Neck/scapula pain

• Paraesthesia

EXAMINATION

LOOK – FEEL -MOVE

• Sterno clavicular joint

• Clavicle

• AC joint

• Coracoid process

• Biceps

• Greater tuberosity

• Rotator cuff

• Joint lines

• Acromion/scapula

• Cervical spine

• Rhythm - anterior • Rhythm - posterior

CHECK FOR CREPITUS

• E.R • I.R.

SPECIAL TESTS

• Impingement • adduction

SPECIAL TESTS

• Speed’s test • O’Brien’s test

SPECIAL TESTS

• Anterior apprehension • Posterior

apprehension

SPECIAL TESTS

• Anterior relocation • Posterior relocation

SPECIAL TESTS

• Sulcus sign • Belly press/lift off

SPECIAL TESTS

• Dynamic SLAP • Generalised lig laxity

SPECIAL TESTS

• Adson’s test

INVESTIGATIONS

Thank you

SHOULDER REPLACEMENT

SURGERY

Indications

• Severe pain

unresponsive to

nonoperative

treatment

• Loss of active and

passive movement

• Interference with ADL

PREOPERATIVE ASSESSMENT

• History

• Examination

• Xrays

• MRA

• 3D CT – if significant

bone pathology

Many choices

All poly glenoid vs metal backed glenoid – cemented vs uncemented – long stem vs short stem - hemiarthroplasty vs TSR vs RTSR

PARADIGM

RC INTACT & GOOD

QUALITY

• ? Hemi / resurfacing if

< 50 years

• TSR in others ( unless

significant glenoid

retroversion then

consider RTSR)

RC TORN ( OR INTACT &

POOR QUALITY)

• RTSR

The future

Patient specific

instrumentation and

prostheses

Pyrocarbon

Thank you

Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF...

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