Shoulder Pain - Proper Diagnostic Testing in Shoulder Pain Cases
Shoulder Pain and Injuries - Wake Orthopaedics › sites › default › files › health... · •...
Transcript of Shoulder Pain and Injuries - Wake Orthopaedics › sites › default › files › health... · •...
1
Shoulder Pain and Injuries
Mark Wood, MD
March 16, 2016
2
Overview
• Anatomy • Overuse vs Acute injuries • Bursitis/impingement/rotator cuff tendinitis • Arthritis • Shoulder separations and dislocations • Labral Tears • Rotator cuff tears • Fractures
• A Medical doctor • Extensive training in treating problems
involving bones, joints, ligaments, muscles, tendons, and cartilage
What is an Orthopaedic Surgeon?
Educating an Orthopaedic Surgeon
• College • Medical School • Internship • Orthopaedic Resident • Fellowship/Board Cert.
Total
4 4 1 4 2-3
15 -16 years
Orthopaedic Surgeon’s DesireGet You Back Into The Game
Accomplish Your Goals
Anatomy
Bone and Joints
6
AnatomySoft-tissue AC joint Biceps tendon Joint capsule, labrum Rotator cuff
Labrum
8
Overuse vs. Acute Injuries
• Overuse - series of excessive and repeated small injuries that results in damage to the tissues.
• Acute - sudden trauma ◼ tears (rotator cuff, biceps tendon, labrum)
◼ strains and sprains (muscle, ligaments, partial tears) ◼ fractures (clavicle)
Overuse Injuries
Shoulder Bursitis, tendinitis, impingement syndrome
9
10
Rotator Cuff Tendinitis/Bursitis, Impingement Syndrome
Rotator Cuff Tendinitis & Bursitis• Shoulder pain with overhead activity • Difficulty sleeping • Primarily an inflammatory process
• Treatment ◼REST! -modify, pain-free activities ◼NSAIDs (Aleve, ibuprofen, mobic) ◼Physical Therapy ◼Cortisone injections into bursa ◼ Surgery rarely needed
11
SHOULDER ARTHRITIS (GLENOHUMERAL JOINT)
Arthritis (Osteoarthritis or DJD)
Arthritis “arthr” = joint (cartilage) “itis” = inflammation
Arthritis = degenerating joint cartilage which leads to joint inflammation
Healthy Joint
Cartilage
Joints – a simple arthritis model
Arthritic Joint
Bone
Pain
Avoidance Of
Motion
Increased Muscle
Tightness
Stiffness
Cartilage loss leads to Inflammation and Pain
Diagnosis - X-Rays
Healthy Shoulder Arthritic Shoulder
Goals of Treatment
1. Relieve pain
2. Increase function
Treatment
• Medications • Vitamins and supplements • Alternative medicine • Joint protection, rest • Physical Therapy and Exercise • Injections with cortisone • Surgery
Treatment Options
Treatment Options – Conservative (non-surgical)
Alternative Medicine
Injections
Supplements
Medications
Exercise & Physical Therapy
Exercise
Exercise
1. Range of motion (stretching) Prevent stiffness, “frozen shoulder”
2. Strengthening muscles Rotator cuff and shoulder peri-scapular
Exercise
• Strengthening Correctly ◼Correct positioning
critical ◼Correct exercises
◼Avoid injury
Failure of Conservative Treatments
Medications
Exercise
Supplements
Physical TherapyNutrition & Weight
SURGERY
FAILEDFAILED
FAILED
FAILED
FAILED
Surgery for arthritis
• Arthroscopy ◼Debridement (cleanup)
◼Address the biceps ◼Remove inflamed tissue ◼Remove loose cartilage
25
Surgery- Joint Replacement
Reverse TSR
26
Acute Shoulder Injuries
AC Separations• Disruption of the acromioclavicular joint after fall
- ligament tears, pain and possible deformity
27
CoracoClavicular ligaments torn
AC Separation - Treatment• Non-op: <100% displaced (Types I, II, III) ◼ Sling, NSAIDS, ice, PT, return to activities when able
• Operative: >100% displaced ◼Goal: restore the anatomy
28
CC ligaments
29
Arthroscopic Repair
Arthroscopic RepairSlipped on ice
30
Wolf, J Arthroscopy 2010Arthrosopic view
of coracoid
• Outcome: ◼ Small, cosmetic incisions ◼ 90% Good/Excellent results
31
Arthroscopic Repair
Wolf, J Arthroscopy 2010
SLAP Tears
• SLAPSuperior Labral Anterior to Posterior tear
• Mechanism Fall, traction injury, overhead athlete
• Symptoms Vague pain, mechanical popping, catching
SLAP (Labral Tear) - Treatment• Surgery is reserved for symptomatic patient
after failing conservative measures
O’Brien, J Arthro 2002, multiple studies
34
SLAP Technique
LabrumBiceps
Glenoid Probe
38
Acute Shoulder Dislocations• Traumatic, Usually requires reduction in ED
with sedation • Imaging ◼X-ray: confirm reduction, r/o bone fractures ◼MRI: evaluate soft-tissue injury (SLAP, Bankart, RC)
39
Shoulder Dislocation - Imaging
Normal Dislocated
Bankart Lesion
Labrum
Traditional TreatmentNonoperative
Traditional TreatmentNonoperative
Acute dislocations • Reduced quickly • Immobilization • Rehabilitation
RehabilitationNO SIGNIFICANT
DIFFERENCE IN REHAB PROTOCOLS
Hovelius, JBJS 1996 ◼10 yr prospective study ◼Younger (<30) = recurrence ◼Older (>50) = rotator cuff tears
Rotator Cuff Tears• RC tendon holds ball into the
socket while lifting arm • Tears may occur with or without
significant injury • Shoulder and upper arm pain • Difficulty sleeping • Arthroscopic repair generally
recommended for active people • RC does not heal therefore tears
become larger and retract
Rotator Cuff Torn = Treatment
Clavicle Fractures• The most common shoulder fracture • Vast majority do well with non-op care • Consider operative treatment only if significantly
displaced
49
Mckee, JBJS 2009
Distal Clavicle Fractures
50
ConclusionsIf you are experiencing shoulder joint pain that alters your
daily activities or sleep, consider conservative options (rest, nsaids, ice, etc)
For more advanced treatment options or when conservative treatment fails, consider visiting an orthopaedic physician or physical therapist
Remember, an Orthopaedic Surgeons desire is to help you get back into the game and accomplish your goals by eliminating pain and maximizing function
What are your questions and concerns?
Thank you for this opportunity
Additional Educational Resources
Http://orthodoc.aaos.org/MarkWoodMD/
www.orthoinfo.org
www.WakeOrtho.com
54
55
Rotator Cuff Advancements
57
58