SHOULDER PART 1

DR.SARKAWT S.KAKAI

TOPICS

• AC arthritisAcromioclavicular

pathology

• Traumatic anterior shoulder instabilityInstability

• Deltoid ruptureTendons

• Subacromial impingement, calcific tendinitis and RC tearsRotator cuffs

• Adhesive capsulitisDegenerative

conditions

• Total shoulder and shoulder arthrodesisShoulder

arthroplasty

AC ARTHRITIS

• MORE COMMON WITH AGE BUT CAN OCCUR BY SECOND DECADE OF LIFE

• MORE COMMON IN WEIGHT-LIFTERS AND OTHER SPORTS

PRESENTATION

• activity related superior shoulder pain with overhead activity

• with cross body arm adductionSymptoms

Physical examination

• pain with direct palpation of AC joint

• prominence of the distal clavicle (osteophytes)

Palpation

• pain with cross body adduction testProvocative

tests

IMAGING

Osteophytes and joint space narrowing

TREATMENT

Conservative

• Activity modification and physical therapy

• physical therapy should focus on strengthening and stretching of shoulder girdle

• AC joint injection with corticosteroids

Operative

• arthroscopic vs. open distal clavicle resection

TUBS (TRAUMATIC UNILATERAL DISLOCATIONS WITH A BANKART LESION REQUIRING SURGERY)

• one of most common shoulder injuries

• 1.7% annual rate in general population

incidence

• anteriorly directed force on the arm when the shoulder is abducted and externally rotated

Mechanism

PRESENTATION

• TRAUMATIC EVENT CAUSING DISLOCATION

• FEELING OF INSTABILITY

• SHOULDER PAIN COMPLAINTS

• CAUSED BY SUBLUXATION AND EXCESSIVE TRANSLATION OF

THE HUMERAL HEAD ON THE GLENOID

• PHYSICAL EXAM

• LOAD AND SHIFT

• APPREHENSION SIGN

• RELOCATION SIGN

• SULCUS SIGN

IMAGING

Radiographs see imaging of shoulder

• a complete trauma series needed for evaluation true AP, axillary

CT scan

• helpful for evaluation of bony injuries

MRI

• best for visualization of labral tear

TREATMENT

Nonoperative

• acute reduction, ± immobilization, followed by therapy

Operative

• Arthroscopic Bankart repair +/-capsular shift

• Open Bankart repair +/- capsular shift

DELTOID RUPTURE

Deltoid ruptures are usually strains or partial tears

• complete ruptures are rare

Epidemiology

• incidence

• rare

• risk factors

• repeated corticosteroid injections about the shoulder

• rotator cuff tear

• trauma

PRESENTATION

Symptoms

• shoulder pain

Physical exam

• inspection

• depression over deltoid

• soft tissue mass distal to depression (contracted muscle)

IMAGING

• RADIOGRAPHS

• FINDINGS

• ASSOCIATED WITH CUFF TEAR ARTHROPATHY

• PROXIMAL HUMERAL HEAD MIGRATION

• ULTRASOUND

• FINDINGS

• SHOWS DELTOID GAP WITH INTACT SURROUNDING FIBERS

• MRI

• FINDINGS

• DELTOID DEFECT

• ASSOCIATED ROTATOR CUFF TEAR

TREATMENT

• NONOPERATIVE

• OBSERVATION ONLY

• INDICATIONS

• CHRONIC INJURIES IN ELDERLY PATIENTS

• OPERATIVE

• EARLY SURGICAL REPAIR

• DELTOPLASTY WITH MOBILIZATION AND ANTERIOR

TRANSFER OF THE MIDDLE THIRD OF THE DELTOID

•THANK YOU