SHOULDER SHOULDER OSTEOLOGY SHOULDER OSTEOLOGY ANATOMY MUSCLES ANATOMY

SHOULDER

SHOULDER OSTEOLOGY

SHOULDER OSTEOLOGY

ANATOMY: MUSCLES

ANATOMY: CAPSULAR ELEMENTS

IMPINGEMENT: ANATOMY CA LIGAMENT

ACROMIAL SHAPES

ACROMIAL ANATOMY

ACROMIAL SHAPE n TYPE 1 (FLAT)17% n TYPE 2 (CURVED) 43% n TYPE 3 (ANTERIOR HOOK) 40% n MORRISON & BIGLIANI (1987) 80% PTS WITH RC TEAR HAD TYPE 3 ACROMION

IMPINGEMENT SYNDROME: STAGES n STAGE 1 : REVERSIBLE EDEMA n STAGE 2: FIBROSIS n STAGE 3: ROTATOR CUFF TEAR

IMPINGEMENT SYNDROME : STAGE 1 n n DULL ACHE ACTIVITY RELATED PALPABLE TENDERNESS PAIN BETWEEN 30 -60 DEGREE ABDUCTION n POSITIVE IMPINGEMENT SIGNS n PAIN IN BICIPITAL GROOVE

IMPINGEMENT SYNDROME: STAGE 1 TREATMENT n NSAID n REST FROM PROVOCATIVE MANUVERS n PHYSICAL THERAPY

IMPINGEMENT SYNDROME: STAGE II DIAGNOSIS n n n ACHING DISCOMFORT PAIN AT REST/NIGHT SUBACROMIAL CREPITUS n CATCHING SENSATION n DECREASED ROM

IMPINGEMENT SYNDROME: STAGE II TREATMENT n n REST ICE NSAID SUBACROMIAL INJECTION P. T 1. R. O. M 2. PAIN CONTROL 3. STRENGTH n ACROMIOPLASTY 86% SUCCESS IF NO RC TEAR n OPEN VS ARTHROSCOPIC

OPEN ACROMIOPLASTY

SUBACROMIAL DECOMPRESSION

ROTATOR CUFF TEARS n n n PREVALENCE ETIOLOGY PHYSICAL EXAM TREATMENT OPTIONS REHABILITATION

ROTATOR CUFF TEARS: INCIDENCE FULL THICKNESS JEROSCH , 1991 -30. 3% NEER , 1983 - 5% UHLHOFF , 1986 -20% WILSON, 1943 -26. 5% n n AGE : KEY FACTOR PARTIAL THICKNESS JEROSCH, 1991 -28. 7% YAMANKA, 1983 -13% FUKUDA, 1980 -13% DEPALMA, 1973 -37% n

R. C TEARS: ETIOLOGY EXTRINSIC FACTORS ACROMIAL SHAPE SUPRASPINATUS NERVE PALSY OUTLET STENOSIS GLENOHUMERAL AC JOINT DJD INSTABILITY OS ACROMIALE n n INTRINSIC FACTORS HYPOVASCULARITY AGING

R. C TEARS: DIAGNOSIS n n n PAIN WEAKNESS(ABD/ER) CREPITUS DROP TEST BURSAL EFFUSION n n LONG HEAD BICEPS RUTURE DECREASED ROM

R. C TEAR : DIAGNOSIS DROP TEST EXTERNAL ROTATION INTERNAL ROTATION

R. C TEAR : IMAGING PLAIN RADIOGRAPHS n ULTRASONOGRAPHY n ARTHROGRAM n MRI: GOLD STANDARD n

R. C TEARS: IMAGING INTACT NORMAL CUFF TORN ROTATOR CUFF

R. C TEARS: XRAYS SOUCIL SIGN SHOULDER ARTHROGRAM

ROTATOR CUFF TEAR: TREATMENT n NON-OPERATIVE ROTATOR CUFF REPAIR ACROMIOPLASTY DISTAL CLAVICLE RESECTION REPAIR OF CUFF n

ROTATOR CUFF REPAIR ACROMIOPLASTY OPEN VS. ARTHROSCOPIC n MOBILIZATION OF TENDON 1. BLUNT DISSECTION 2. RELEASE FASCIAL ATTACHMENTS 3. INCISE CAPSULE AT GLENOID LABRUM n

ARTHROSCOPIC SUBACROMIAL DECOMPRESSION SUBACROMIAL SPUR FINISHED ACROMIOPLASTY

ROTATOR CUFF REPAIR 1. CREATE TROUGH 2. DRILL HOLES 3. NON-ABSORBABLE SUTURES 4. SOLID DELTOID REPAIR n

ROTATOR CUFF REPAIR

ARTHROSCOPIC ROTATOR CUFF REPAIR

ROTATOR CUFF REPAIR: REHABILITATION WEEK 0 -6 PASSIVE R. O. M n WEEK 6 -12 ACTIVE R. O. M n WEEK 12+ STRENGTHENING n

ROTATOR CUFF REPAIR: RESULTS n NEER 1988 -233 PATIENTS, 4. 6 YEAR F. U. 77% EXCELLENT/GOOD 14% SATISFACTORY 9% UNSATISFACTORY n HAWKINS 1985 86% EXCELLENT/GOOD

ROTATOR CUFF REPAIR: RESULTS HARRYMAN, 1990 - 112 PATIENTS 4. 7 YEAR F. U. 80% GOOD PAIN RELIEF 80% REPIRS INTACT(S. S) 50% REPAIRS INTACT(IS, SUBSCAP) n PAIN RELIEF INDEPENDENT OF CUFF INTEGRITY n DECOMPRESSION IS THE KEY!! n

ROTATOR CUFF REPAIR: REASONS FOR FAILURE POST-OP SCARRING n DELTOID DETACHMENT n INADEQUATE DECOMPRESSION n RECURRENT TEAR n