SHOULDER

SHOULDER OSTEOLOGY

SHOULDER OSTEOLOGY

ANATOMY:MUSCLES

ANATOMY:CAPSULAR ELEMENTS

IMPINGEMENT:ANATOMY CA LIGAMENT

ACROMIAL SHAPES

ACROMIAL ANATOMY

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

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

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

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

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

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

OPEN ACROMIOPLASTY

SUBACROMIAL DECOMPRESSION

ROTATOR CUFF TEARS 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% AGE : KEY FACTOR PARTIAL THICKNESS JEROSCH, 1991-28.7% YAMANKA, 1983-13% FUKUDA, 1980-13% DEPALMA, 1973-37%

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

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

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

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

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

R.C TEARS: XRAYS SOUCIL SIGN SHOULDER ARTHROGRAM

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

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

ARTHROSCOPIC SUBACROMIAL DECOMPRESSION SUBACROMIAL SPUR FINISHED ACROMIOPLASTY

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

ROTATOR CUFF REPAIR

ARTHROSCOPIC ROTATOR CUFF REPAIR

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

ROTATOR CUFF REPAIR: RESULTS NEER 1988-233 PATIENTS, 4.6 YEAR F.U. 77% EXCELLENT/GOOD 14% SATISFACTORY 9% UNSATISFACTORY 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) PAIN RELIEF INDEPENDENT OF CUFF INTEGRITY DECOMPRESSION IS THE KEY!!

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