1. Shoulder Problems in Women Laith A. Farjo, M.D. Community Orthopedic Surgery Ypsilanti /Ann Arbor Howell Saline www.communityorthopedics.com

3. Shoulder pain in women A common problem Not always the same cause as in men Very treatable A common problem Not always the same cause as in men Very treatable

4. Goals of this discussion Better understand how the shoulder works Learn what can go wrong with it Discover techniques we use to treat shoulder problems Identify who you should turn to with these problems Better understand how the shoulder works Learn what can go wrong with it Discover techniques we use to treat shoulder problems Identify who you should turn to with these problems

5. Shoulder anatomy The shoulder is a ball and socket joint:

6. Shoulder anatomy The shoulder is surrounded by many muscles These include: –deltoid –trapezius –rotator cuff The shoulder is surrounded by many muscles These include: –deltoid –trapezius –rotator cuff

7. Rotator cuff A group of muscles that control shoulder motion

8. Shoulder anatomy Ligaments surround shoulder and help to keep the joint in socket An “O”-ring, called the labrum, around the glenoid (socket), also helps to keep the joint in place Ligaments surround shoulder and help to keep the joint in socket An “O”-ring, called the labrum, around the glenoid (socket), also helps to keep the joint in place

9. Shoulder anatomy

11. Shoulder function The purpose of the shoulder is to position the hand in space

12. Shoulder function The shoulder is able to do this by: –being flexible –being strong The shoulder is able to do this by: –being flexible –being strong

13. Shoulder flexibility Reasons for flexibility –design: round ball on a flat socket –ligaments: help with stability –muscles: help with stability Reasons for flexibility –design: round ball on a flat socket –ligaments: help with stability –muscles: help with stability

14. Shoulder strength Reasons for strength –many different muscles work together to move the shoulder rotator cuff deltoid trapezius Reasons for strength –many different muscles work together to move the shoulder rotator cuff deltoid trapezius

16. Rotator cuff tendonitis Also known as: –bursitis –impingement syndrome Also known as: –bursitis –impingement syndrome

17. Rotator cuff tendonitis

18. Symptoms: –shoulder pain –hurts to sleep on shoulder at night –twisting motions may hurt shoulder –lifting shoulder above the head can cause pain Symptoms: –shoulder pain –hurts to sleep on shoulder at night –twisting motions may hurt shoulder –lifting shoulder above the head can cause pain

19. Rotator cuff tendonitis Treatment: –Anti-inflammatory medications –Physical therapy –Injections –Surgery to remove bone spur Treatment: –Anti-inflammatory medications –Physical therapy –Injections –Surgery to remove bone spur

20. Rotator cuff tear

21. Symptoms: –similar to tendonitis, but: –shoulder is also weak Symptoms: –similar to tendonitis, but: –shoulder is also weak

22. Rotator cuff tear Treatment: –Anti-inflammatory medications –Physical therapy –Injections –Surgery to fix tendon tear Treatment: –Anti-inflammatory medications –Physical therapy –Injections –Surgery to fix tendon tear

23. Rotator cuff tear

24. Labral tear

25. Symptoms: –shoulder pain –clicking with shoulder motion –shoulder “gives way” secondary to pain Symptoms: –shoulder pain –clicking with shoulder motion –shoulder “gives way” secondary to pain

26. Labral tear Treatment: –Surgery to fix tear of cartilage Treatment: –Surgery to fix tear of cartilage

27. Instability

28. Dislocation: –Shoulder “pops out of socket” –Often due to trauma/violent force –May need to be put back in place in the Emergency Room Dislocation: –Shoulder “pops out of socket” –Often due to trauma/violent force –May need to be put back in place in the Emergency Room

29. Instability Subluxation: –Shoulder slips out of socket and then comes back into place –Patient might not realize the shoulder is coming out of socket –MORE COMMON IN WOMEN! Subluxation: –Shoulder slips out of socket and then comes back into place –Patient might not realize the shoulder is coming out of socket –MORE COMMON IN WOMEN!

30. Instability Treatment: –Depends on age of patient –Physical therapy to strengthen muscles –Avoidance of activities that cause instability –Surgery to tighten up ligaments Treatment: –Depends on age of patient –Physical therapy to strengthen muscles –Avoidance of activities that cause instability –Surgery to tighten up ligaments

31. Instability

32. Arthritis

33. Symptoms: pain, loss of motion 2 kinds: –Osteoarthritis - cartilage wears thin with age –Rheumatoid - body attacks cartilage and eats it away Rheumatoid arthritis more common in women Symptoms: pain, loss of motion 2 kinds: –Osteoarthritis - cartilage wears thin with age –Rheumatoid - body attacks cartilage and eats it away Rheumatoid arthritis more common in women

34. Arthritis

35. Frozen Shoulder

36. Symptoms: –Loss of motion –May or may not be painful More common in women, especially those with diabetes Symptoms: –Loss of motion –May or may not be painful More common in women, especially those with diabetes

37. Frozen Shoulder Treatment: –Physical therapy –Manipulation –Surgery to release adhesions (scar tissue) Treatment: –Physical therapy –Manipulation –Surgery to release adhesions (scar tissue)

39. Where to go for help Primary care doctor –may feel comfortable: diagnosing your problem giving you medications ordering tests sending you for physical therapy administering an injection

40. Where to go for help Physical therapist –helps you to regain motion –gives you exercises to strengthen shoulder muscles –uses “modalities” such as ultrasound to relieve pain

41. Orthopedic surgeon –specializes in the treatment of bone and joint problems –is skilled in both non-operative and operative treatment of shoulder problems –will try to solve your problem without surgery first –type of surgery performed depends on skill/training/experience of surgeon Where to go for help

42. Types of Orthopedic Surgeons General orthopedist Shoulder surgeon Arthroscopic surgeon Sports medicine surgeon

43. Laith A. Farjo, M.D. Community Orthopedic Surgery Howell, Ypsilanti, Saline www.communityorthopedics.com