Shoulder Pain: problems and solutions Ms. Ruth A. Delaney Consultant Orthopaedic Surgeon, Shoulder Specialist
Background
The Shoulder
Bones of the Shoulder Image from
Muscles, Tendons, Ligaments
Shoulder Pain: Where to start? Shoulder history & exam (GP/physio/shoulder specialist) Diagnosis o Xrays are often very helpful o MRI is not always the first thing to do! In some cases, you may never need an MRI or you may need a different type of scan (arthrogram, CT etc.) Plan o Further imaging to complete diagnosis o Anti-inflammatory medication o Physiotherapy o Injections o Surgery
Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures
Rotator Cuff Disease
Group of 4 muscles around the shoulder joint Function in shoulder joint stability and contribute to certain movements The tendons often degenerate over time Partial tears Tendinitis Impingement Full thickness tears MRI may be appropriate if rotator cuff weakness is found on clinical exam
Impingement
Full thickness tear
Treatment Options Physiotherapy Injections with local anaesthetic and corticosteroid (anti- inflammatory effect) Surgery o Arthroscopic subacromial decompression – keyhole surgery to clean out the inflammation, shave any bone spur, and remove any possible sources of pain o Rotator Cuff Repair – some tears are repairable, usually done as keyhole/arthroscopic surgery, rehabilitation takes approx. 6 months o Reverse Shoulder Replacement – in certain situations when a tear is very large and not repairable and the shoulder function is poor
Rotator Cuff Repair
Reverse Shoulder Replacement
Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures
Shoulder Arthritis
Treatment Options Injections o Steroid + local anaesthetic (reduces inflammation) o Viscosupplementation (attempts to replenish joint fluid) ?Arthroscopy o In some situations, keyhole surgery to “clean out” the inflamed tissue, shave loose flaps of cartilage, and smooth bone spurs may be considered o Results are usually temporary Shoulder Replacement o The most definitive way to treat shoulder arthritis o Longevity of the replacement will be negatively affected by heavy use of the shoulder or high impact activities
Shoulder Replacement
Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures
AC (AcromioClavicular) Joint
AC Arthritis Treatment Options Often seen on Xrays and MRIs without causing symptoms If symptomatic: o Anti-inflammatories o Steroid + local anaesthetic injections o Keyhole surgery to shave down the arthritic bone ends
Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures
Frozen Shoulder
Most cases will resolve without surgery The inflammatory process “burns itself out” Freezing, frozen, thawing stages Pain and discomfort can be severe, therefore attempts are made to shorten the process Steroids o Tablets in some cases o Injections Some patients go on to need surgical release of the capsule and manipulation of the shoulder under anaesthesia Gentle physiotherapy Pool exercises
Frozen Shoulder
Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures
Shoulder Fractures
Not all shoulder fractures need to be fixed Important to have a specialist opinion early, in order to decide if any surgery is needed Shoulder Fractures
Summary There are many potential causes of shoulder pain and dysfunction There are many ways to treat these problems History & Exam – Diagnosis – Treatment Plan MRI is not always required Non-surgical options exist for some problems Shoulder surgeries vary in terms of post-op rehab
Coming soon…
Thank You Ms. Ruth Delaney Suite 14, Sports Surgery Clinic