My “Achy Breaky ” Shoulder Shoulder Pain and Treatment
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Transcript of My “Achy Breaky ” Shoulder Shoulder Pain and Treatment
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My My “Achy Breaky” “Achy Breaky” ShoulderShoulder
Shoulder Pain and TreatmentShoulder Pain and Treatment
Kennedy Club Fitness, Paso
Mark G. Kowall, M.D., M.B.A.
September 24, 2013September 24, 2013
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Knee and Shoulder Training
The Orthopedic Specialty Hospital
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Shoulder PainShoulder PainMost common sources
ImpingementRotator Cuff Problems
InstabilityLabrum Tears
Trauma
Less Common Sources ArthritisArthritis
Frozen ShoulderFrozen Shoulder
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AnatomyAnatomy
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Impingement SyndromeImpingement Syndrome(“umbrella diagnosis”)(“umbrella diagnosis”)
Bursitis Bursitis (25-40 y/o)(25-40 y/o)
Tendinitis Tendinitis (40-50 y/o)(40-50 y/o)
Rotator Cuff TearRotator Cuff Tear (>50 y/o)(>50 y/o)
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ImpingementImpingement“Bursitis/Tendinitis”“Bursitis/Tendinitis”
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Pain with overhead motionPain with overhead motionShoulder to elbow locationShoulder to elbow location
Night time awakeningNight time awakeningPain with liftingPain with lifting
Occasional neck pain radiationOccasional neck pain radiationUsually no numbness/tinglingUsually no numbness/tingling
““Bursitis/Tendinitis”Bursitis/Tendinitis”SymptomsSymptoms
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ExamExam XRaysXRays
NSAID’sNSAID’sPhysical Therapy or Home TherapyPhysical Therapy or Home Therapy
Steroid InjectionSteroid Injection
MRIMRI
““Bursitis/Tendinitis”Bursitis/Tendinitis”TreatmentTreatment
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Surgical TreatmentSurgical Treatment““Decompression”Decompression”
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Rotator Cuff TearRotator Cuff Tear
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Rotator Cuff TearRotator Cuff Tear
Similar Symptoms as BursitisSimilar Symptoms as BursitisMore painMore pain
More weaknessMore weaknessSometimes specific trauma Sometimes specific trauma butbut
More often “age related”More often “age related”
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MRIMRIEdge of tendon
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Rotator Cuff RepairRotator Cuff Repair
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InstabilityInstability(Labrum Tears)(Labrum Tears)
S.L.A.P. Lesion
Bankart Lesion
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Repair of the Labrum through the Arthroscope
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TraumaTraumaShoulder SeparationShoulder Separation
AC JointAC Joint
Fall off Bike onto shoulderFall off Bike onto shoulder
Usually no surgeryUsually no surgery
(Depends on severity)(Depends on severity)
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TraumaTraumaShoulder DislocationShoulder Dislocation
““Ball and Socket” JointBall and Socket” Joint
Often requires ER visit Often requires ER visit
Can lead to recurrent dislocationsCan lead to recurrent dislocations
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TraumaTraumaFractureFracture
Common in older population Common in older population
(Usually no surgery)(Usually no surgery)
Younger population Younger population
(more frequent surgery)(more frequent surgery)
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Healthy Joint
Osteoarthritic Joint
“tread wear”
Cartilage
““Arthritis”Arthritis”==
“Tread Wear”“Tread Wear”
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ArthritisArthritis“Acromioclavicular Joint”“Acromioclavicular Joint”
Normal
Arthritis
Common in younger patients “Weight lifters”, construction workers
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Acromioclavicular JointAcromioclavicular JointTreatmentTreatment
NSAID’sNSAID’s
Activity ModificationActivity Modification
Steroid injectionSteroid injection
Arthroscopic SurgeryArthroscopic Surgery
(Removal of arthritic end of clavicle)(Removal of arthritic end of clavicle)
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ArthritisArthritis“Ball and Socket Joint”“Ball and Socket Joint”
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Shoulder X-RayShoulder X-RayArthritisArthritis
Normal AdvancedArthritis
Joint Space
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Arthroscopy – Arthroscopy – MicrofractureMicrofracture
small awl used to make holes in small awl used to make holes in bonebone
promote re-growth of cartilagepromote re-growth of cartilage
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Shoulder ReplacementShoulder Replacement
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Frozen ShoulderFrozen Shoulder(Adhesive Capsulitis)(Adhesive Capsulitis)
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Frozen Shoulder Frozen Shoulder TreatmentTreatment
Pain control (NSAID’s, steroid medication and injection)
Physical Therapy
TIME, TIME, TIME
Sometimes manipulation of shoulder under general anesthesia
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Information ResourceInformation Resource
www.ShoulderKneeSpecialists.comwww.ShoulderKneeSpecialists.com