Dr…….MY SHOULDER

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ramsayhealth.com Alain ISERIN Consultant Shoulder Surgeon Oaks Hospital Colchester 15.11.2021 Dr…….MY SHOULDER

Transcript of Dr…….MY SHOULDER

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Alain ISERIN

Consultant Shoulder Surgeon Oaks Hospital Colchester 15.11.2021

Dr…….MY SHOULDER

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PAIN IS THE MOST FREQUENT CONDITION

FOR SHOULDER CONSULTATIONS

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ANALYSE THE PAIN

Is it following an accident or a fall?

Sudden start/Progressive start

Chronic evolution?

Is it related to movements?

Worse or better with rest at night?

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SHOULDER PAIN

ASSOCIATED FACTORS OR SIGNS

.Age

.Physical activity: work, sport

.Motion assessment

.Strength evaluation

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SIMPLE CLINICAL ANALYSIS

AND PLAIN XRAY

often guide to the

most common pathologies

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INSTABILITY

. Young patient, sport activity

. Following an initial trauma episode

. Related to movements

. Sometimes subluxation or dislocation

. Xray Hill Sachs, Glenoid fracture

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REFERRAL FOR

. Arthro MRI : labrum tear,

. Arthroscopic repair

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IMPINGEMENT

. Age 40 +

. Night pain

. Typical manouvers

.Test injection in the bursa

. Xray spur underneath the acromion.

. US no complete tendon tear

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REFERRAL IF

. Medications and injections temporary relief

. MRI partial tendon tear

. Arthroscopic decompression

Intratendinous

Bursal side

Articular side

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ROTATOR CUFF TEAR

. Age 50 +

. Permanent pain.

. Weakness 1,2 or 3 tendons

. Xray sometimes migration humeral head

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REFERRAL FOR

. MRI size, muscle value

. Arthroscopic repair

. Tendons too retracted: Reverse shoulder

Fat - Sat

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CALCIFIC TENDINITIS

. Age 30 to 40. women

. Bilateral often

. Acute pain sometimes

. Stiffness

. Xray

. Injection in the bursa

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REFERRAL IF

. Pain and calcium still present after injection

and medications

. Arthroscopic calcium removal

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ARTHRITIS. Age 50 +

. Chronic pain

. Stiffness

. Weakness sometimes

. Xray centered or excentered

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REFERRAL IF. Pain unbearable after medications and physio

. MRI to assess joint and tendons

. Reverse shoulder replacement + - graft

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ACROMIO CLAVICULAR PATHOLOGY

. Acute: AC joint dislocation (fall)

Xray superior migration distal clavicle

. Chronic

Sport++ weight lifting

pain on the as joint: injection

Xray: images

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REFERRAL FOR

.Acute: young patients Stabilization

.Chronic: pain still present after injection

Arthroscopic resection distal clavicle

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FROZEN SHOULDER

. Permanent pain

. Age 30 to 60

. Diabetes sometimes

. Stiffness in all directions

. Xray normal

. Injection difficult

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REFERRAL

For guided injections only

No surgery..

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CONCLUSION

ACURATE CLINICAL EXAMINATION

DIAGNOSIS


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