common shoulder conditions in general practice
DESCRIPTION
Common Shoulder Conditions in General Practice. Mr. T P Selvan MB, LRCP, FRCS Ed, MSc (Ortho), FRCS (Ortho) Consultant Orthopaedic Surgeon East Surrey Hospital Redhill. Scope. Anatomy Diagnostic clues Examination Investigations (X-ray indications) Injection- indications & techniques - PowerPoint PPT PresentationTRANSCRIPT
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Mr. T P SelvanMB, LRCP, FRCS Ed, MSc (Ortho), FRCS (Ortho)
Consultant Orthopaedic SurgeonEast Surrey Hospital
Redhill
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Anatomy Diagnostic clues Examination Investigations (X-ray indications) Injection- indications & techniques Referral to Orthopaedic Specialist Red flag signs Surgical procedures performed
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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
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HISTORY Pain on overhead activities Impingement
Night Pain Rotator cuff disease, GH arthritis,Frozen shoulder
Dead arm Instabiltiy
Trauma Rotator cuff tear, Fracture
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LOCATION OF PAIN
Rotator cuff disease
1. Under deltoid
2. Side of arm
3. Front of arm
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Pain in the shoulder
blade area (location 4) is usually muscular or nerve related
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Wasting of supraspinous and infraspinous fossae Long head of biceps
rupture
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SUPRACLAVICULAR FOSSA
NEUROLOGICAL EXAMINATION
VASCULAR EXAMINATION
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CERVICAL SPONDYLOSIS
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CERVICAL SPINE FRACTURE AND TUMOUR
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ACTIVE/PASSIVE
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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
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Abduction in scapular plane
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ELBOW AT 90 DEGREES
Ext. Rotation against resistance
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GERBER’S LIFT OFF TEST
BELLY PRESS (NAPOLEON’S) TEST
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SPEED’S TEST
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NEER’S IMPINGEMENT TEST
GREAT CAUTION! IN YOUNG PATIENTS CLOSELY EVALUATE FOR SIGNS OF INSTABILITY, THE MOST LIKELY CAUSE OF IMPINGEMENT
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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
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ACJ arthritis Acromial spur
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OSTEO ARTHRITIS
ROTATOR CUFF ARTHROPATHY
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PATHOLOGICAL FRACTURE
CALCIFICATION
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Ultrasound (one stop clinic)
MRI Arthrogram CT Scan EMG Bone Scan ARTHROSCOPY
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Rest
NSAIDs / Analgesia
Physiotherapy
Steroid Injection
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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
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a) Subacromial spaceb) Glenohumeral joint
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Subacromial space
Palpate the posterolateral corner of acromion
1-2 cm below and medial to point
Needle directed towards the coracoid process
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Glenohumeral joint
Palpate the coracoid process
1-2 cm below and lateral to point
Needle directed towards the joint
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Failure of conservative treatment for 6 months
Signs & Symptoms of INSTABILITY Suspected ACUTE ROTATOR CUFF TEAR Uncertain diagnosis Red flags
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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.
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Subacromial Impingement
Subacromial decompression
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RECONSTRUCTIVEANTERIOR STABILISATION
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Surface replacement Total shoulder replacement
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Reverse Delta Shoulder replacement
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