Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF...

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Dr Jerome Goldberg Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg www.orthosports.com.au

Transcript of Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF...

Page 1: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

Dr Jerome GoldbergShoulder Surgery

ASSESSMENT OF THE STIFF

SHOULDER

Dr Jerome Goldberg

www.orthosports.com.au

Page 2: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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DEFINITION

Loss of

• active movment &

• passive movement

Page 3: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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CASE

• 55 yr old lady

• Housewife

• No trauma

• Family history NIDDM

• 3 month history of

increasing lateral arm

and night pain

• Noticed loss of ROM

over last 6 weeks

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CASE

• Active elevation 90

• IR to sacrum

• Power normal

• Passive elevation 90

• ER 0

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CASE

WHAT INVESTIGATIONS SHOULD WE ORDER?

A. Xray

B. Utlrasound

C. MRI or MRA

D. A & B

E. A & C

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CASE

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CASE

WHAT IS THE DIAGNOSIS?

A. Adhesive Capsulitis

B. Osteoarthritis

C. Locked posterior dislocation

D. Tumour

E. None of the above

Page 8: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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CAUSES

• Adhesive capsulitis

• Osteoarthritis

• Post operative

• Dislocations – mainly the

locked posterior

dislocation

• tumour

• Hysterical

shoulder/compensation

Page 9: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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HISTORY

• Age

• Hand dominance

• Occupation

• Recreational activities

• Sports

• Previous shoulder ops

• Medical history

– Arthritis

– Diabetes/thyroid

• Family history

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HISTORY

• Trauma

• Length of symptoms

• Location of pain

• exacerbating and relieving

factors

• Night discomfort

• Loss of movement

• Loss of power

• Neurological symptoms

Page 11: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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HISTORY

Beware of

• Rest pain

• Constant pain

• Neck/scapula pain

• Paraesthesia

Page 12: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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EXAMINATION

LOOK – FEEL -MOVE

Page 13: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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LOOK

Page 14: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Page 15: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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FEEL

• Sterno clavicular joint

• Clavicle

• AC joint

• Coracoid process

• Biceps

• Greater tuberosity

• Rotator cuff

• Joint lines

• Acromion/scapula

• Cervical spine

Page 16: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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MOVE

• Rhythm - anterior • Rhythm - posterior

CHECK FOR CREPITUS

Page 17: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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MOVE

Page 18: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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MOVE

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POWER

• E.R • I.R.

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SPECIAL TESTS

• Impingement • adduction

Page 21: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SPECIAL TESTS

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SPECIAL TESTS

• Speed’s test • O’Brien’s test

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SPECIAL TESTS

• Anterior apprehension • Posterior

apprehension

Page 24: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SPECIAL TESTS

• Anterior relocation • Posterior relocation

Page 25: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SPECIAL TESTS

• Sulcus sign • Belly press/lift off

Page 26: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SPECIAL TESTS

• Dynamic SLAP • Generalised lig laxity

Page 27: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SPECIAL TESTS

• Adson’s test

Page 28: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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INVESTIGATIONS

Page 29: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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INVESTIGATIONS

Page 30: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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INVESTIGATIONS

Page 31: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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INVESTIGATIONS

Page 32: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Thank you

Page 33: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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SHOULDER REPLACEMENT

SURGERY

Indications

• Severe pain

unresponsive to

nonoperative

treatment

• Loss of active and

passive movement

• Interference with ADL

Page 34: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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PREOPERATIVE ASSESSMENT

• History

• Examination

• Xrays

• MRA

• 3D CT – if significant

bone pathology

Page 35: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Page 36: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Page 37: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Many choices

All poly glenoid vs metal backed glenoid – cemented vs uncemented – long stem vs short stem - hemiarthroplasty vs TSR vs RTSR

Page 38: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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PARADIGM

RC INTACT & GOOD

QUALITY

• ? Hemi / resurfacing if

< 50 years

• TSR in others ( unless

significant glenoid

retroversion then

consider RTSR)

RC TORN ( OR INTACT &

POOR QUALITY)

• RTSR

Page 39: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Page 40: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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The future

Patient specific

instrumentation and

prostheses

Pyrocarbon

Page 41: Assessment of the Stiff Shoulder - Shoulder Surgery · Shoulder Surgery ASSESSMENT OF THE STIFF SHOULDER Dr Jerome Goldberg . Dr Jerome Goldberg Shoulder Surgery DEFINITION Loss of

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Thank you


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