Common Shoulder Conditions in General Practice
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Transcript of Common Shoulder Conditions in General Practice
Mr. T P SelvanMB, LRCP, FRCS Ed, MSc (Ortho), FRCS (Ortho)
Consultant Orthopaedic SurgeonEast Surrey Hospital
Redhill
Anatomy Diagnostic clues Examination Investigations (X-ray indications) Injection- indications & techniques Referral to Orthopaedic Specialist Red flag signs Surgical procedures performed
AGE 10-35 yrs Instability
30-50 yrs AC joint disease
40-60 yrs Frozen Shoulder
>60 yrs GH arthritiis
35-75 yrs Rotator cuff disease
HISTORY Pain on overhead activities Impingement
Night Pain Rotator cuff disease, GH arthritis,Frozen shoulder
Dead arm Instabiltiy
Trauma Rotator cuff tear, Fracture
LOCATION OF PAIN
Rotator cuff disease
1. Under deltoid
2. Side of arm
3. Front of arm
Pain in the shoulder
blade area (location 4) is usually muscular or nerve related
Wasting of supraspinous and infraspinous fossae Long head of biceps
rupture
SUPRACLAVICULAR FOSSA
NEUROLOGICAL EXAMINATION
VASCULAR EXAMINATION
CERVICAL SPONDYLOSIS
CERVICAL SPINE FRACTURE AND TUMOUR
ACTIVE/PASSIVE
DELTOID FUNCTION SUPRASPINATUS FUNCTION TERES MINOR/INFRASPINATUS FUNCTION DROP SIGN SUBSCAPULARIS FUNCTION 1. GERBER’S LIFT OFF TEST 2. NAPOLEON’S BELLY PRESS TEST BICEPS TENDON 1. YERGASSON’S TEST 2. SPEED’S TEST
Abduction in scapular plane
ELBOW AT 90 DEGREES
Ext. Rotation against resistance
GERBER’S LIFT OFF TEST
BELLY PRESS (NAPOLEON’S) TEST
SPEED’S TEST
NEER’S IMPINGEMENT TEST
GREAT CAUTION! IN YOUNG PATIENTS CLOSELY EVALUATE FOR SIGNS OF INSTABILITY, THE MOST LIKELY CAUSE OF IMPINGEMENT
Why do we need X-rays?
Frozen Shoulder to exclude other pathology
Rotator cuff disease◦ Impingement Sclerosis GT and Acromion◦ Cuff tear Superior migration of
humerus(+/-)◦ Cuff arthropathy Humero-acromial articulation
Instability Hill Sachs lesion
Glenohumeral OA AC joint dislocation / OA
ACJ arthritis Acromial spur
OSTEO ARTHRITIS
ROTATOR CUFF ARTHROPATHY
PATHOLOGICAL FRACTURE
CALCIFICATION
Ultrasound (one stop clinic)
MRI Arthrogram CT Scan EMG Bone Scan ARTHROSCOPY
Rest
NSAIDs / Analgesia
Physiotherapy
Steroid Injection
Indications for Injection Diagnostic
Subacromial impingement Acromioclavicular joint pain Aspiration
Therapeutic Subacromial impingement Rotator cuff tendinitis / Bursitis Calcific tendinitis Glenohumeral OA Long head of biceps tendinitis Frozen Shoulder AC joint arthritis
a) Subacromial spaceb) Glenohumeral joint
Subacromial space
Palpate the posterolateral corner of acromion
1-2 cm below and medial to point
Needle directed towards the coracoid process
Glenohumeral joint
Palpate the coracoid process
1-2 cm below and lateral to point
Needle directed towards the joint
Failure of conservative treatment for 6 months
Signs & Symptoms of INSTABILITY Suspected ACUTE ROTATOR CUFF TEAR Uncertain diagnosis Red flags
Infection : red hot skin, pyrexial, systemically unwell
Unreduced dislocation: h/o trauma/fit/electric shock, abnormal contour, loss of movements
Acute rotator cuff tear: acute onset pain and weakness, recent trauma, drop arm sign
Tumour: S/S of cancer, h/o cancer, abnormal mass, swelling or deformity
Neurological: severe sensori-motor deficit, unexplained muscle wasting.
Subacromial Impingement
Subacromial decompression
RECONSTRUCTIVEANTERIOR STABILISATION
Surface replacement Total shoulder replacement
Reverse Delta Shoulder replacement