Shoulder

• Impingement Syndrome/Rotator Cuff Disease

  Overview

  RTC disease is a continuum beginning with mild impingement and progressing toward partial RTC tear, full-thickness RTC tear, massive tear, and finally RTC arthropathy.

  Overview

  Physical examination

  Patients typically present with an insidious onset of pain exacerbated by overhead activities. Complaints of night discomfort, pain in the deltoid region, muscular weakness, and differences in active versus passive ROM are common, with more significant weakness and loss of motion indicating a higher degree of cuff involvement.

  Radiographs

  May demonstrate classic changes within the acromion. With chronic RTC pathology, superior migration of the humeral head with extensive degenerative change may be present.

  Treatment

  Nonoperative treatment

  Initially indicated for impingement syndrome, Activity modification, , and an aggressive RTC and scapular-stabilizer strengthening program are initiated. Additionally, oral anti-inflammatory medications, therapeutic modalities, and judicious use of subacromial steroid injections may be implemented.

  Chronic impingement syndrome

  Symptoms that are refractory to a minimum of 4-6 months of nonoperative treatment may respond favorably to subacromial decompression. Similarly, patients indicated for RTC repair will often require concomitant subacromial decompression at the time of repair.

  

• Anterior instability – dislocation

  Due to the shoulder's extensive ROM, it is at risk for developing instability and is the most commonly dislocated joint in the body. Instability is a pathologic condition manifesting as pain due to excessive translation of the humeral head on the glenoid during active shoulder motion, Diagnosis is based on history, physical examination, and imaging.

  

  Treatment

  First-time dislocations—Debate still exists regarding the treatment of first-time dislocations. External rotation bracing for 3-6 weeks has been effective in decreasing the short-term rates of recurrent dislocation. The lowest rates of recurrent dislocation (generally <10%) are seen after operative treatment, either open or arthroscopic. The newest data show that arthroscopic anterior stabilization is equivalent to open repairs. Some have advocated repair of first-time dislocations because of the decreased rate of dislocation 6 years after repair and the higher quality of life associated with operative treatment.

• Posterior instability

  

  When they are recognized, posterior dislocations respond well to acute reduction and immobilization. Patients may present with their arms internally rotated, with observable coracoid and posterior prominence. An axillary lateral radiograph is extremely helpful in making the diagnosis. Rehabilitation focuses on RTC and deltoid strengthening, with surgical management reserved for refractory cases.

• Acromioclavicular Separation

  

  Overview

  These injuries are typically caused by a direct blow to the shoulder, are common athletic injuries, and can be classified into six types

  Treatment

  Treatment of type 1 and 2 non operative treatment Management of type III injuries is somewhat controversial, we prefer non operative treatment Management of types IV through VI injuries-These are typically treated surgically.

• Acromioclavicular Osteoarthritis

  

  Due to the transmission of large loads through a small surface area, the AC joint may begin to degenerate as early as the second decade. Additionally, direct blows or low-grade AC separation may cause post-traumatic arthritis. The condition is diagnosed by direct palpation, radiographic evidence of osteophytes and joint-space narrowing, and pain relief with selective AC joint injection. Treatment includes both open and arthroscopic distal clavicle resections (Mumford procedure).

• A SLAP tear or SLAP lesion

  

  A SLAP tear or SLAP lesion is an injury to the Glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym that stands for "superior labral tear from anterior to posterior". Difficulty sleeping due to shoulder discomfort. The SLAP lesion decreases the stability of the joint which when combined with lying in bed causes the shoulder to drop. For an athlete involved in a throwing sport such as baseball, pain and a catching feeling are prevalent. Throwing athletes may also complain of a loss of strength or significant decrease velocity in throwing. Treatment involves débridement (types I and III) with or without stabilization of the biceps anchor (types II and IV).

• Calcifying tendinitis

  

  A self-limiting condition of unknown etiology that affects predominantly the supraspinatus tendon and occurs slightly more frequently in women. Radiographs demonstrate characteristic calcification within the tendon. Nonoperative treatment is the rule, consisting of physical therapy, modalities, and injections. Arthroscopic or open removal of the deposit is occasionally necessary.

• Biceps tendinitis

  

  Often associated with impingement, RTC tears (subscapularis and leading-edge supraspinatus tears), and stenosis of the bicipital groove Diagnosis is made by direct palpation, with the arm internally rotated 10 degrees, and confirmed with Speed and Yergason tests. Initial management includes strengthening and local injection (around but not into the tendon). Surgical release is usually reserved for refractory cases.

• Distal clavicle osteolysis

  

  Common in weightlifters and those with a history of traumatic injury. Radiographs of the distal clavicle reveal osteopenia, osteolysis, and cystic changes. After failure of selective corticosteroid injection, NSAIDs, and activity modification, this condition responds favorably to distal clavicle excision.

• Shoulder Osteoarthritis

  

  Shoulder Osteoarthritis (Degenerative Arthritis of the Shoulder)

  Your risk of developing osteoarthritis of the shoulder with its pain and physical limitations increases with age. But an injury, such as a dislocated shoulder, can lead to shoulder osteoarthritis even in young people

  What Is Osteoarthritis?

  Osteoarthritis - also known as degenerative joint disease -- occurs when the cartilage that covers the tops of bones, known as articular cartilage, degenerates or wears down. This causes swelling, pain, and sometimes the development of osteophytes -- bone spurs -- when the ends of the two bones rub together.

  What Is Osteoarthritis of the Shoulder?

  The shoulder is made up of two joints, the acromioclavicular (AC) joint and the glenohumeral joint. The AC joint is the point where the collarbone, or clavicle, meets the acromion, which is the tip of the shoulder blade. The glenohumeral joint is the point where the top of the arm bone, or humerus, meets the shoulder blade, or scapula. Osteoarthritis is more commonly found in the AC joint.

  Who Gets Shoulder Osteoarthritis?

  Osteoarthritis most often occurs in people who are over the age of 50. In younger people, osteoarthritis can result from an injury or trauma, such as a fractured or dislocated shoulder. This is known as posttraumatic arthritis. Osteoarthritis may also be hereditary.

  What Are the Symptoms of Shoulder Osteoarthritis?

  As with most types of osteoarthritis, pain is a key symptom. A person with shoulder arthritis is likely to have pain while moving the shoulder as well as after moving the shoulder. The person can even have pain while sleeping.

  Another symptom may be a limited range of motion. This limitation can be seen when you are trying to move your arm. It can also be evident if someone is moving your arm to assess range of motion. Moving the shoulder might also produce a clicking or creaking noise.

  How Is Shoulder Osteoarthritis Diagnosed?

  To diagnose shoulder osteoarthritis, the doctor will take a medical history and do a physical exam to assess pain, tenderness, and loss of motion and to look for other signs in surrounding tissues. At this point, the doctor may be able to tell if the muscle near the joint has signs of atrophy, or weakness, from lack of use. Tests that might be ordered to diagnose osteoarthritis of the shoulder include: X-rays, Blood tests, mainly to look for rheumatoid arthritis, but also to exclude other diseases MRI scans

  

  How Is Osteoarthritis of the Shoulder Treated?

  The first treatments for osteoarthritis, including osteoarthritis of the shoulder, do not involve surgery. These treatments include:

  • Resting the shoulder joint. This could mean that the person with arthritis has to change the way he moves the arm while performing the activities of daily living. Taking over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or aspirin. These drugs, also called NSAIDS, will reduce inflammation and pain. Check with your doctor to make sure you can take these drugs safely.
  • Performing range-of-motion exercises. These exercises are used as an attempt to increase flexibility.
  • Applying moist heat. Applying ice to the shoulder. Ice is applied for 20 minutes two or three times a day to decrease inflammation and pain.
  • Using other medications prescribed by the doctor. These might include injections of corticosteroids, for example.
  • Taking the dietary supplements glucosamine and chondroitin. Many people claim relief with these supplements. Evidence is conflicting as to whether they really help. You should discuss using these with your doctor because the supplements may interact with other drugs.

  
  

  

  If nonsurgical treatments do not work effectively, there are surgeries available. As with any surgery, there are certain risks and potential complications, including infection or problems with anesthesia. Surgical treatments include:

  

  Shoulder joint replacement (total shoulder arthroplasty).

  Replacing the whole shoulder with an artificial joint is usually done to treat arthritis of the glenohumeral joint.

  Replacement of the head of the humerus, or upper arm bone (hemiarthroplasty)

  This option, too, is used to treat arthritis of the glenohumeral joint.

  Removal of a small piece of the end of the collarbone (resection arthroplasty)

  This option is the most common surgery for treating arthritis of the AC joint.